Zincke H, Oesterling J E, Blute M L, Bergstralh E J, Myers R P, Barrett D M
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905.
J Urol. 1994 Nov;152(5 Pt 2):1850-7. doi: 10.1016/s0022-5347(17)32399-6.
To provide information about long-term outcome after radical prostatectomy for clinically localized prostatic cancer (stage T2c or lower), we undertook a retrospective analysis of 3,170 consecutive patients (mean age 65.3 +/- 6.4 years, range 31 to 81) with a mean followup of 5 years. Complication rates for patients who underwent prostatectomy before 1988 were compared with those who underwent radical prostatectomy more recently. Of the patients 49 (1.5%), 178 (5.6%), 897 (28%) and 2,047 (65%) had clinical stages T1a, T1b, T2a and T2b,c disease, respectively. The Gleason score was 3 or less in 292 patients (9%) and 7 or greater in 782 (25%). Overall, 438 patients (14%) died, 159 (5%) of cancer. The crude 10 and 15-year survival rates for all patients were 75% and 60%, respectively, which is comparable to the expected survival of a control group (67% and 46%). The cause specific survival rates were 90% and 82%, respectively, metastasis-free survival rates 82% and 76%, local recurrence-free survival rates 83% and 75%, overall recurrence-free rates 72% and 61%, and overall recurrence plus prostate specific antigen progression-free (greater than 0.2 ng./ml.) rates 52% and 40%, respectively. Clinical stage did not significantly affect survival but tumor grade was associated: 10 and 15-year cause specific survival rates were 95% and 93%, respectively, for a Gleason score of 3 or less, 90% and 82%, respectively, for a score of 4 to 6, and 82% and 71%, respectively, for a score of 7 or more. Of all patients 26% received adjuvant treatment (hormonal and/or radiation) within 3 months postoperatively because of advanced local pathological stage (pT3 or higher) or margin positive disease. The 30-day mortality rate was 0.3% (0% for 1,728 patients who underwent surgery in 1988 or later). Only 1 patient in the 70 year or older age group died during hospitalization. Complications decreased with time. In a contemporary group the complications were rectal injury in 0.6% of the patients, colostomy in 0.06%, myocardial infarction in 0.4%, deep venous thrombosis in 1.1%, pulmonary embolism in 0.7% and total urinary incontinence (3 or more pads per day) in 0.8%. Recent intraoperative blood loss was a median of 600 ml., and the incidence of recent need for any transfusion was 31% and it is presently less than 5%. In this series patients undergoing radical prostatectomy for clinically localized prostate cancer were usually healthy and, thus, had low co-morbidity. Survival rates at 10 and 15 years compare favorably with those of an age-matched control group.(ABSTRACT TRUNCATED AT 400 WORDS)
为了提供临床局限性前列腺癌（T2c期或更低分期）根治性前列腺切除术后的长期预后信息，我们对3170例连续患者（平均年龄65.3±6.4岁，范围31至81岁）进行了回顾性分析，平均随访时间为5年。将1988年以前接受前列腺切除术的患者的并发症发生率与最近接受根治性前列腺切除术的患者的并发症发生率进行比较。在这些患者中，49例（1.5%）、178例（5.6%）、897例（28%）和2047例（65%）分别患有临床T1a、T1b、T2a和T2b、c期疾病。Gleason评分在292例患者（9%）中为3分或更低，在782例患者（25%）中为7分或更高。总体而言，438例患者（14%）死亡，159例（5%）死于癌症。所有患者的10年和15年粗生存率分别为75%和60%，这与对照组的预期生存率（67%和46%）相当。病因特异性生存率分别为90%和82%，无转移生存率分别为82%和76%，无局部复发生存率分别为83%和75%，总体无复发生存率分别为72%和61%，总体复发加前列腺特异性抗原无进展（大于0.2 ng/ml）生存率分别为52%和40%。临床分期对生存率没有显著影响，但肿瘤分级与之相关：Gleason评分为3分或更低时，10年和15年病因特异性生存率分别为95%和93%；评分为4至6分时，分别为90%和82%；评分为7分或更高时，分别为82%和71%。在所有患者中，26%因局部病理分期晚期（pT3或更高）或切缘阳性疾病在术后3个月内接受了辅助治疗（激素和/或放疗）。30天死亡率为0.3%（1988年或以后接受手术的1728例患者中为0%）。70岁及以上年龄组中只有1例患者在住院期间死亡。并发症随时间减少。在一个当代组中，并发症包括0.6%的患者发生直肠损伤、0.06%的患者发生结肠造口术、0.4%的患者发生心肌梗死、1.1%的患者发生深静脉血栓形成、0.7%的患者发生肺栓塞以及0.8%的患者发生完全尿失禁（每天使用3个或更多尿垫）。近期术中失血量中位数为600 ml，近期需要输血的发生率为31%，目前低于5%。在这个系列中，因临床局限性前列腺癌接受根治性前列腺切除术的患者通常健康，因此合并症发生率较低。10年和15年的生存率与年龄匹配的对照组相比具有优势。（摘要截断于400字）
