Ozawa Yu, Sharma Rohan, Moschovas Marcio Covas, Sandri Marco, Saikali Shady, Rogers Travis, Patel Vipul
AdventHealth Global Robotics Institute, Celebration, FL, USA.
Urology Department, University of Central Florida (UCF), Orlando, FL, USA.
Ann Surg Oncol. 2025 Jul 14. doi: 10.1245/s10434-025-17745-4.
The study aimed to identify potential candidates for adjuvant radiotherapy by stratifying patients with locally advanced prostate cancer based on their biochemical recurrence (BCR) risk.
This study analyzed data from 3536 men with pT3-4 disease who achieved undetectable prostate-specific antigen (PSA) levels after robot-assisted radical prostatectomy between 2008 and 2023. Kaplan-Meier curves and log-rank tests were used to compare BCR risk across pathologic T (pT) stages. The study also evaluated associations between BCR and other adverse pathologic features, including pathologic grade group (GG), pathologic N (pN) stage, positive surgical margin, perineural invasion, lymphovascular invasion, tumor diameter, and tumor percentage involvement. A multivariable Cox regression was used to adjust for potential confounders, including age, race, Charlson Comorbidity Index, and PSA at biopsy.
The median follow-up period was 60 months (interquartile range [IQR], 24-84 months), with BCR occurring in 852 patients. The patients with pT3b and pT4 disease had higher BCR risk (hazard ratio [HR], 2.54; 95% confidence interval [CI], 2.19-2.94) than those with pT3a disease (HR, 2.10; 95% CI, 1.51-2.93). In the multivariable analysis, the independent predictors for BCR were GG3-5, pT3b, lymphovascular invasion, positive surgical margin, and tumor diameter, with GG5 having the strongest prognostic significance. The combination of GG3-5 and the cumulative number of these adverse features further stratified BCR risk (p < 0.001).
The study demonstrated that patients with GG5 locally advanced disease and multiple adverse pathologic features have the highest BCR risk after achieving undetectable PSA levels. These patients are potential candidates for adjuvant radiotherapy and should receive comprehensive counseling regarding its potential benefits. Prospective studies are warranted to optimize patient selection for adjuvant therapy.
本研究旨在通过根据生化复发（BCR）风险对局部晚期前列腺癌患者进行分层，确定辅助放疗的潜在候选者。
本研究分析了2008年至2023年间3536例pT3-4期疾病患者的数据，这些患者在机器人辅助根治性前列腺切除术后前列腺特异性抗原（PSA）水平检测不到。采用Kaplan-Meier曲线和对数秩检验比较不同病理T（pT）分期的BCR风险。该研究还评估了BCR与其他不良病理特征之间的关联，包括病理分级组（GG）、病理N（pN）分期、手术切缘阳性、神经周围侵犯、淋巴管侵犯、肿瘤直径和肿瘤累及百分比。采用多变量Cox回归调整潜在混杂因素，包括年龄、种族、Charlson合并症指数和活检时的PSA。
中位随访期为60个月（四分位间距[IQR]，24 - 84个月），852例患者发生BCR。pT3b和pT4期疾病患者的BCR风险（风险比[HR]，2.54；95%置信区间[CI]，2.19 - 2.94）高于pT3a期疾病患者（HR，2.10；95% CI，1.51 - 2.93）。在多变量分析中，BCR的独立预测因素为GG3 - 5、pT3b、淋巴管侵犯、手术切缘阳性和肿瘤直径，其中GG5具有最强的预后意义。GG3 - 5与这些不良特征的累积数量相结合进一步分层了BCR风险（p < 0.001）。
该研究表明，GG5期局部晚期疾病且具有多种不良病理特征的患者在PSA水平检测不到后BCR风险最高。这些患者是辅助放疗的潜在候选者，应接受关于其潜在益处的全面咨询。有必要进行前瞻性研究以优化辅助治疗的患者选择。
