Zincke H, Bergstralh E J, Blute M L, Myers R P, Barrett D M, Lieber M M, Martin S K, Oesterling J E
Department of Urology, Mayo Clinic, Rochester, MN.
J Clin Oncol. 1994 Nov;12(11):2254-63. doi: 10.1200/JCO.1994.12.11.2254.
To determine the efficacy and complication rate of radical prostatectomy (RP) as a treatment option for clinically localized prostate cancer (clinical stage < or = T2c).
The study was a retrospective analysis of 1,143 consecutive patients (median age, 64 years; range, 38 to 79 y) who underwent RP at one institution (mean follow-up time, 9.7 years). Complications for this study population were compared with those of a contemporary group of 1,000 consecutive patients.
Of 1,143 patients, 83 (7%) had a low clinical stage (T1) and 160 (14%) had a low histologic grade (Gleason score < or = 3); 648 (57%) had a high clinical stage (T2b or T2c) and 204 (18%) had a high histologic grade (Gleason score > or = 7). Only 113 (10%) died of prostate cancer, and 177 (15%) developed metastasis. Adjuvant treatment (androgen deprivation or radiation therapy) was given in 197 (17%) patients (> or = pT3) and provided virtually identical results as without adjuvant treatment. The 10- and 15-year crude survival rates for 1,143 patients were 75% +/- 1.5% (SE) and 60% +/- 2.2%, respectively; the cause-specific survival rates were 90% +/- 1.1% and 83% +/- 1.9%, respectively; and the metastasis-free survival rates were 83% +/- 1.3% and 77% +/- 1.9%, respectively (398 men at risk at 10 years and 138 men at risk at 15 years). The 10-year survival rate for patients with Gleason score > or = 7 was 74% +/- 3.9%. Only tumor grade was a significant predictor for disease outcome. The hospital mortality rate decreased from 0.7% for the 1,143 study patients to 0% for the more recent 1,000 patients. Severe incontinence declined to 1.4% for the more recent 1,000 patients. Most patients who underwent RP were healthy (Charlson comorbidity index).
Survival at 15 years was similar to the expected survival rate. Current morbidity and mortality rates associated with RP were extremely low. Thus, RP has been a viable management option for men with clinically localized prostate cancer who have a life expectancy of more than 10 years.
确定根治性前列腺切除术（RP）作为临床局限性前列腺癌（临床分期≤T2c）治疗选择的疗效和并发症发生率。
本研究是对在同一机构接受RP的1143例连续患者（中位年龄64岁；范围38至79岁）进行的回顾性分析（平均随访时间9.7年）。将该研究人群的并发症与同期1000例连续患者的并发症进行比较。
1143例患者中，83例（7%）临床分期低（T1），160例（14%）组织学分级低（Gleason评分≤3）；648例（57%）临床分期高（T2b或T2c），204例（18%）组织学分级高（Gleason评分≥7）。仅113例（10%）死于前列腺癌，177例（15%）发生转移。197例（17%）患者（≥pT3）接受了辅助治疗（雄激素剥夺或放射治疗），其结果与未接受辅助治疗的患者几乎相同。1143例患者的10年和15年粗生存率分别为75%±1.5%（SE）和60%±2.2%；病因特异性生存率分别为90%±1.1%和83%±1.9%；无转移生存率分别为83%±1.3%和77%±1.9%（10年时398例处于风险中，15年时138例处于风险中）。Gleason评分≥7的患者10年生存率为74%±3.9%。仅肿瘤分级是疾病预后的显著预测因素。1143例研究患者的医院死亡率从0.7%降至最近1000例患者的0%。最近1000例患者中严重尿失禁发生率降至1.4%。大多数接受RP的患者健康（Charlson合并症指数）。
15年生存率与预期生存率相似。目前与RP相关的发病率和死亡率极低。因此，对于预期寿命超过10年的临床局限性前列腺癌男性患者，RP一直是一种可行的治疗选择。
