Smitt M C, Heltzel M
Department of Radiation Oncology, Stanford University Medical Center, CA 94305, USA.
Cancer. 1996 Mar 1;77(5):928-33. doi: 10.1002/(sici)1097-0142(19960301)77:5<928::aid-cncr19>3.0.co;2-5.
The use of radical prostatectomy in the treatment of prostate cancer has increased with the advent of prostate specific antigen (PSA) screening. Few series have examined the relapse rates after prostatectomy relative to pre-treatment prognostic factors, such as preoperative PSA and Gleason scores. The characteristics and outcome of patients diagnosed with prostate cancer and treated with radical prostatectomy at community hospitals in the prostate specific antigen era have not been described in detail.
The tumor registry records were obtained for all patients diagnosed with prostate cancer and treated with radical prostatectomy at Washington Hospital, Fremont, CA, from 1990 through 1993. The clinical and pathologic characteristics, including the original pathology report, for the 100 patients were reviewed by a single physician. Relapse was defined by the persistence or appearance of a PSA value greater than 0.2 ng/mL (Hybritech, Inc., San Diego, CA) following surgery or by clinical evidence of recurrent disease. Crude and actuarial probabilities of relapse were analyzed relative to pre-treatment PSA values, Gleason score, pathologic stage, and surgical margin status. The median follow-up time was 2.5 years.
The pT-classification distribution of the 100 cases was as follows: T1, 4%; T2A, 14%; T2B, 11%; T2C, 49%; T3A, 8%; T3B, 2%; T3C, 6%; and N+, 6%. Pretreatment PSA values were less than or equal to 4 ng/mL for 10 patients, greater than 4 to 10 ng/mL for 38 patients, greater than 10 to 20 ng/mL for 27 patients, and greater than 20 ng/mL for 13 patients. The value was unknown for 12 patients. The Gleason score was less than or equal to 5 for 40%, 6 for 17%, 7 for 31%, and 8 to 10 for 12%. Positive surgical margins were noted in 30% of the patients. The actuarial probability of overall survival and freedom from relapse for the entire group of patients at 3 years was 95% and 73%, respectively. Pre-treatment PSA values greater than 20 ng/mL, Gleason score greater than or equal to 7, and pT3 classification were significant predictors of relapse in univariate analysis. Preoperative PSA greater than 20 ng/mL and Gleason score were significant prognostic factors in multivariate analysis. Pathologic margin status was not a significant predictor of relapse in this experience.
Short-term relapse rates are high among those patients with preoperative PSA values greater then 20 ng/mL or Gleason scores greater than or equal to 7. Overall results of radical prostatectomy at this community hospital were similar to those reported at referral centers.
随着前列腺特异性抗原（PSA）筛查的出现，根治性前列腺切除术在前列腺癌治疗中的应用有所增加。很少有系列研究探讨前列腺切除术后的复发率与术前预后因素的关系，如术前PSA和 Gleason评分。在前列腺特异性抗原时代，社区医院诊断为前列腺癌并接受根治性前列腺切除术的患者的特征和结局尚未得到详细描述。
获取了1990年至1993年在加利福尼亚州弗里蒙特市华盛顿医院诊断为前列腺癌并接受根治性前列腺切除术的所有患者的肿瘤登记记录。由一名医生回顾了100例患者的临床和病理特征，包括原始病理报告。复发定义为术后PSA值持续或出现大于0.2 ng/mL（Hybritech公司，加利福尼亚州圣地亚哥），或有疾病复发的临床证据。分析了相对于术前PSA值、Gleason评分、病理分期和手术切缘状态的粗复发概率和精算复发概率。中位随访时间为2.5年。
100例病例的pT分期分布如下：T1，4%；T2A，14%；T2B，11%；T2C，49%；T3A，8%；T3B，2%；T3C，6%；N+，6%。10例患者术前PSA值小于或等于4 ng/mL，38例患者大于4至10 ng/mL，27例患者大于10至20 ng/mL，13例患者大于20 ng/mL。12例患者的值未知。Gleason评分小于或等于5的占40%，6的占17%，7的占31%，8至10的占12%。30%的患者手术切缘阳性。整个患者组3年的总生存和无复发精算概率分别为95%和73%。在单因素分析中，术前PSA值大于20 ng/mL、Gleason评分大于或等于7和pT3分期是复发的显著预测因素。在多因素分析中，术前PSA大于20 ng/mL和Gleason评分是显著的预后因素。在本研究中，病理切缘状态不是复发的显著预测因素。
术前PSA值大于20 ng/mL或Gleason评分大于或等于7的患者短期复发率较高。这家社区医院根治性前列腺切除术的总体结果与转诊中心报告的结果相似。
