Pisansky T M, Blute M L, Suman V J, Bostwick D G, Earle J D, Zincke H
Division of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
Int J Radiat Oncol Biol Phys. 1996 Oct 1;36(3):585-91. doi: 10.1016/s0360-3016(96)00359-8.
This study was conducted to identify pretherapy factors associated with seminal vesicle invasion (SVI) in patients with localized carcinoma of the prostate (CaP), and to develop a model that would allow estimation of the likelihood for SVI at the time of initial diagnosis.
Between January 1988 and December 1993, 2959 patients underwent radical retropubic prostatectomy, with or without pelvic lymph node dissection, as initial therapy for clinical Stage T1a-3bN0-XM0 CaP. Preoperative patient and tumor-related characteristics were evaluated for an association with SVI in univariate and multivariate logistic regression analyses. A model was developed and probability plots were constructed to display the estimated likelihood for SVI in the patients with a new diagnosis of localized CaP.
Within clinical tumor stage, three groups (T1a-2a, T2b-c, and T3a-b) were observed to have a distinctly different rate of SVI. Gleason primary grades were combined (1-2, 3 and 4-5) because of a similar observation. Univariate analysis identified clinical tumor stage (p < 0.0001), Gleason primary grade (p < 0.0001), and serum prostate-specific antigen level (p < 0.0001) as factors associated with the likelihood for SVI. Multivariate analysis confirmed the independent significance (p = 0.0001) of each of these factors. Patient age (p = 0.16) and history of prior transurethral resection of the prostate (p = 0.82) were not associated with this end point. Probability plots were constructed to display the likelihood of SVI as a function of pretherapy clinical tumor stage, Gleason primary grade, and serum prostate-specific antigen value.
In the patient with a new diagnosis of localized CaP, clinical tumor stage as determined by digital rectal examination, diagnostic biopsy tumor (Gleason primary) grade, and pretherapy serum prostate-specific antigen value were significant factors for development of a model that estimated the likelihood of SVI. Estimates from this type of model may be of value in the pretherapy diagnostic evaluation of such patients, and may aid in the administration of radiation therapy.
本研究旨在确定局限性前列腺癌（CaP）患者精囊侵犯（SVI）相关的治疗前因素，并建立一个模型，用于估计初始诊断时发生SVI的可能性。
1988年1月至1993年12月期间，2959例患者接受了耻骨后根治性前列腺切除术，部分患者同时进行或未进行盆腔淋巴结清扫，作为临床分期为T1a - 3bN0 - XM0的CaP的初始治疗。在单因素和多因素逻辑回归分析中，评估术前患者和肿瘤相关特征与SVI的相关性。建立了一个模型，并构建概率图以显示新诊断为局限性CaP的患者发生SVI的估计可能性。
在临床肿瘤分期内，观察到三组（T1a - 2a、T2b - c和T3a - b）的SVI发生率明显不同。由于观察结果相似，将Gleason主要分级合并为（1 - 2、3和4 - 5）。单因素分析确定临床肿瘤分期（p < 0.0001）、Gleason主要分级（p < 0.0001）和血清前列腺特异性抗原水平（p < 0.0001）为与SVI可能性相关的因素。多因素分析证实了这些因素各自的独立显著性（p = 0.0001）。患者年龄（p = 0.16）和既往经尿道前列腺切除术史（p = 0.82）与该终点无关。构建概率图以显示SVI可能性作为治疗前临床肿瘤分期、Gleason主要分级和血清前列腺特异性抗原值的函数。
对于新诊断为局限性CaP的患者，通过直肠指检确定的临床肿瘤分期、诊断性活检肿瘤（Gleason主要）分级和治疗前血清前列腺特异性抗原值是建立估计SVI可能性模型的重要因素。这种类型模型的估计值可能在这类患者的治疗前诊断评估中有价值，并可能有助于放射治疗的实施。
