D'Amico A V, Whittington R, Malkowicz S B, Schultz D, Schnall M, Tomaszewski J E, Wein A
Joint Center for Radiation Therapy, Harvard Medical School, Boston, Massachussetts, USA.
Urology. 1997 Mar;49(3A Suppl):23-30. doi: 10.1016/s0090-4295(97)00165-9.
This study was performed to predict the factors that can optimize preoperative staging for clinically localized prostate cancer patients.
Logistic and Cox regression multivariable analyses were performed on 480 surgically-managed prostate cancer patients to evaluate the ability of clinical stage, prostate specific antigen (PSA), biopsy Gleason sum, percent positive biopsies, and endorectal coil magnetic resonance imaging (erMRI) results to predict for pathologic established extracapsular extension (ECE), seminal vesicle invasion (SVI), and time to postoperative PSA failure.
The characteristics of clinically organ-confined prostate cancer patients at high risk (> 67%) for postoperative PSA failure within 3 years include: (A) PSA > 20 ng/mL; (B) Biopsy Gleason sum > or = 8; or (C) erMRI positive for extraprostatic disease and intermediate risk disease. For patients at intermediate risk (ie, either a PSA < 4 and biopsy Gleason sum of 7; PSA > 4 to 10 ng/mL and biopsy Gleason sum 5 to 7; or a PSA > 10 to 20 ng/mL and biopsy Gleason sum 2 to 7), despite 100% positive biopsies, 50% of patients had pathologic organ-confined disease. However, in the subset of intermediate-risk patients with a positive erMRI for either ECE or SVI and at least 50% positive biopsies, all had extraprostatic disease and failed biochemically by 47 months postoperatively. Intermediate-risk patients with < 50% positive biopsies had pathologic organ-confined disease in at least 77% of the cases.
Combined modality staging using the PSA, biopsy Gleason sum, percent positive biopsies, and endorectal coil MRI findings in select patients can predict pathologic stage and postoperative PSA failure. Therefore, this combined modality staging may optimize patient selection for phase 3 trials examining the role of neoadjuvant androgen ablative therapy for patients with clinically localized disease.
本研究旨在预测可优化临床局限性前列腺癌患者术前分期的因素。
对480例接受手术治疗的前列腺癌患者进行逻辑回归和Cox回归多变量分析，以评估临床分期、前列腺特异性抗原（PSA）、活检Gleason评分总和、阳性活检百分比以及直肠内线圈磁共振成像（erMRI）结果预测病理证实的包膜外侵犯（ECE）、精囊侵犯（SVI）和术后PSA失败时间的能力。
3年内术后PSA失败高危（>67%）的临床器官局限性前列腺癌患者的特征包括：（A）PSA>20 ng/mL；（B）活检Gleason评分总和≥8；或（C）erMRI显示前列腺外疾病和中度风险疾病阳性。对于中度风险患者（即PSA<4且活检Gleason评分总和为7；PSA>4至10 ng/mL且活检Gleason评分总和为5至7；或PSA>10至20 ng/mL且活检Gleason评分总和为2至7），尽管活检阳性率为100%，但50%的患者患有病理器官局限性疾病。然而，在中度风险患者亚组中，erMRI显示ECE或SVI阳性且活检阳性率至少为50%，所有患者均有前列腺外疾病，术后47个月生化指标失败。活检阳性率<50%的中度风险患者中，至少77%的病例患有病理器官局限性疾病。
在特定患者中使用PSA、活检Gleason评分总和、阳性活检百分比和直肠内线圈MRI结果进行联合分期，可以预测病理分期和术后PSA失败。因此，这种联合分期可能优化患者选择，用于研究新辅助雄激素剥夺疗法对临床局限性疾病患者作用的3期试验。
