Pound C R, Partin A W, Epstein J I, Walsh P C
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Urol Clin North Am. 1997 May;24(2):395-406. doi: 10.1016/s0094-0143(05)70386-4.
In a series of 1623 men with a follow-up of 5 +/- 3 years (range 1-13) after anatomic RRP for clinically localized prostate cancer, 17% (276/1623) have shown recurrence. A detectable PSA was the only evidence of recurrence in 7.9%, whereas 2.5% have recurred locally and 5.4% have developed distant metastases. The overall actuarial progression-free rate for these men at 10 years was 68%. Actuarial rates at 10 years were 18% for development of an isolated PSA recurrence, 8% for local recurrence, and 9% for distant recurrence. The actuarial likelihood of a postoperative recurrence increased with increasing clinical stage, Gleason score, preoperative PSA level, and pathologic stage. Although not shown in our previous report, the actuarial rate of recurrence of tumors with a Gleason score of 7 was statistically different from that of tumors of higher Gleason score (8-10). As well, men with preoperative PSA levels of 10.1 to 20 ng/mL experienced recurrence at a significantly lower rate than did men with preoperative PSA levels greater than 20 ng/mL. By using a combination of Gleason score, pathologic stage, and surgical margin status, we demonstrated that the presence of a positive surgical margin did not dramatically affect recurrence in tumors of Gleason scores 2 to 6 with capsular penetration. Surgical margin status was important in high-grade tumors with capsular penetration. In fact, tumors with capsular penetration, Gleason score of at least 7, and a positive surgical margin behaved similarly to tumors with invasion of the seminal vesicles. Preservation of potency did not adversely influence cancer control. The Gleason score, presence or absence of seminal vesicle or lymph node involvement, and the timing of PSA recurrence are all important variables in predicting eventual local versus distant failure associated with an isolated rise in serum PSA. Overall actuarial cause-specific survival at 5 and 10 years was 99% and 93%. Although there was no difference in survival among men grouped by TNM stage or preoperative PSA, advancing histologic grade and pathologic stage did have an effect on actuarial cause-specific survival. Men undergoing RRP for clinically localized prostate cancer showed a 16% actuarial rate of development of metastatic disease at 10 years. This is considerably better than conservative therapy and justifies RRP as the treatment of choice for men with clinically localized disease who are otherwise healthy and have a greater than 10-year life expectancy.
在一系列1623例接受解剖性根治性前列腺切除术治疗临床局限性前列腺癌的男性患者中，随访时间为5±3年（范围1 - 13年），17%（276/1623）出现复发。7.9%的患者复发的唯一证据是可检测到的前列腺特异抗原（PSA），而2.5%为局部复发，5.4%发生远处转移。这些男性患者10年时的总体无进展精算率为68%。10年时孤立性PSA复发的精算率为18%，局部复发为8%，远处复发为9%。术后复发的精算可能性随临床分期、Gleason评分、术前PSA水平和病理分期的增加而增加。虽然在我们之前的报告中未显示，但Gleason评分为7的肿瘤的复发精算率与更高Gleason评分（8 - 10）的肿瘤在统计学上有差异。同样，术前PSA水平为10.1至20 ng/mL的男性患者的复发率明显低于术前PSA水平大于20 ng/mL的男性患者。通过结合Gleason评分、病理分期和手术切缘状态，我们证明手术切缘阳性对包膜侵犯且Gleason评分为2至6的肿瘤的复发没有显著影响。手术切缘状态在包膜侵犯的高级别肿瘤中很重要。事实上，包膜侵犯、Gleason评分至少为7且手术切缘阳性的肿瘤与侵犯精囊的肿瘤表现相似。保留性功能对癌症控制没有不利影响。Gleason评分、精囊或淋巴结是否受累以及PSA复发的时间都是预测与血清PSA单独升高相关的最终局部与远处失败的重要变量。5年和10年时的总体精算特定病因生存率分别为99%和93%。虽然按TNM分期或术前PSA分组的男性患者在生存率上没有差异，但组织学分级和病理分期的进展确实对精算特定病因生存率有影响。接受解剖性根治性前列腺切除术治疗临床局限性前列腺癌 的男性患者10年时发生转移性疾病的精算率为16%。这比保守治疗要好得多，证明解剖性根治性前列腺切除术是适合临床局限性疾病、身体健康且预期寿命超过10年的男性患者的首选治疗方法。
