Chierigo Francesco, Flammia Rocco Simone, Sorce Gabriele, Hoeh Benedikt, Hohenhorst Lukas, Panunzio Andrea, Tian Zhe, Saad Fred, Graefen Marcus, Gallucci Michele, Briganti Alberto, Montorsi Francesco, Chun Felix K H, Shariat Shahrokh F, Antonelli Alessandro, Guano Giovanni, Mantica Guglielmo, Borghesi Marco, Suardi Nazareno, Terrone Carlo, Karakiewicz Pierre I
Department of Surgical and Diagnostic Integrated Sciences, University of Genova, Genova, Italy.
IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Curr Urol. 2024 Jun;18(2):128-132. doi: 10.1097/CU9.0000000000000188. Epub 2024 Jun 21.
This study aimed to test the association between of type and number of D'Amico high-risk criteria (DHRCs) with cancer-specific mortality (CSM) in high-risk prostate cancer patients treated with radical prostatectomy.
In the Surveillance, Epidemiology, and End Results database (2004-2016), we identified 31,281 radical prostatectomy patients with at least 1 DHRC, namely, prostate-specific antigen (PSA) >20 ng/mL (hrPSA), biopsy Gleason Grade Group (hrGGG) score of 4 and 5, or clinical tumor stage ≥T3 (hrcT). Multivariable Cox regression models and competing risks regression models (adjusting for other cause mortality) tested the association between DHRCs and 5-year CSM.
Of 31,281 patients, 14,394 (67%) exclusively harbored hrGGG, 3189 (15%) harbored hrPSA, and 1781 (8.2%) harbored hrcT. Only 2132 patients (6.8%) harbored a combination of the 2 DHRCs, and 138 (0.6%) had all 3 DHRCs. Five-year CSM rates ranged from 0.9% to 3.0% when any individual DHRC was present (hrcT, hrPSA, and hrGGG, in that order), 1.6% to 5.9% when 2 DHRCs were present (hrPSA-hrcT, hrcT-hrGGG, and hrPSA-hrGGG, in that order), and 8.1% when all 3 DHRCs were present. Cox regression models and competing risks regression confirmed the independent predictor status of DHRCs for 5-year CSM that was observed in univariable analyses, with hazard ratios from 1.00 to 2.83 for 1 DHRC, 2.35 to 5.88 for combinations of 2 DHRCs, and 7.13 for all 3 DHRCs.
Within individual DHRCs, hrcT and hrPSA exhibited weaker effects than hrGGG did. Moreover, a dose-response effect was identified according to the number of DHRCs. Accordingly, the type and number of DHRCs allow further risk stratification within the high-risk subgroup.
本研究旨在检验接受根治性前列腺切除术的高危前列腺癌患者中，达米科高危标准（DHRCs）的类型和数量与癌症特异性死亡率（CSM）之间的关联。
在监测、流行病学和最终结果数据库（2004 - 2016年）中，我们确定了31281例接受根治性前列腺切除术且至少有一项DHRC的患者，即前列腺特异性抗原（PSA）>20 ng/mL（hrPSA）、活检Gleason分级组（hrGGG）评分为4和5或临床肿瘤分期≥T3（hrcT）。多变量Cox回归模型和竞争风险回归模型（针对其他原因死亡率进行调整）检验了DHRCs与5年CSM之间的关联。
在31281例患者中，14394例（67%）仅存在hrGGG，3189例（15%）存在hrPSA，1781例（8.2%）存在hrcT。仅有2132例患者（6.8%）存在两种DHRCs的组合，138例（0.6%）存在所有三种DHRCs。当存在任何一项单独的DHRC时（依次为hrcT、hrPSA和hrGGG），5年CSM率在0.9%至3.0%之间；当存在两种DHRCs时（依次为hrPSA - hrcT、hrcT - hrGGG和hrPSA - hrGGG），5年CSM率在1.6%至5.9%之间；当存在所有三种DHRCs时，5年CSM率为8.1%。Cox回归模型和竞争风险回归证实了在单变量分析中观察到的DHRCs作为5年CSM独立预测因素的地位，一项DHRC的风险比为1.00至2.83，两项DHRCs组合的风险比为2.35至5.88，三项DHRCs的风险比为7.13。
在各单独的DHRCs中，hrcT和hrPSA的影响比hrGGG弱。此外，根据DHRCs的数量确定了剂量反应效应。因此，DHRCs的类型和数量可在高危亚组内进行进一步的风险分层。
