D'Amico A V, Whittington R, Schultz D, Malkowicz S B, Tomaszewski J E, Wein A
Joint Center for Radiation Therapy, Harvard Medical School, Boston, Massachusetts, USA.
J Urol. 1997 Oct;158(4):1422-6.
Some patients with clinically localized prostate cancer are not cured after radical prostatectomy because of the presence of occult systemic disease. The American Joint Commission on Cancer staging classification for prostate cancer does not reliably distinguish between clinically localized patients who are likely or unlikely to be cured after local therapy. This project was undertaken to develop a staging system capable of predicting long-term outcome after radical prostatectomy on the basis of the clinical parameters obtained routinely during the standard workup for patients with adenocarcinoma of the prostate.
A total of 688 clinically localized prostate cancer patients managed with a radical retropubic prostatectomy for adenocarcinoma of the prostate between 1989 and 1996 was evaluated for clinical features predictive of time to prostate specific antigen (PSA) failure using a Cox regression multivariate analysis. A recently defined clinical factor called the calculated prostate cancer volume and its ability to predict time to PSA failure in conjunction with PSA, biopsy Gleason score and clinical stage were evaluated.
The calculated prostate cancer volume (p <0.0001) and the pretreatment PSA (p <0.001) provided the optimal staging system for predicting freedom from PSA failure after radical prostatectomy.
The calculated prostate cancer volume and PSA may provide clinically useful information regarding outcome after radical prostatectomy, enabling the selection of a therapeutic approach for an individual patient with clinically localized disease. Validation of this staging system is needed.
一些临床局限性前列腺癌患者在根治性前列腺切除术后未被治愈，原因是存在隐匿性全身疾病。美国癌症联合委员会（American Joint Commission on Cancer）的前列腺癌分期分类不能可靠地区分局部治疗后可能治愈或不太可能治愈的临床局限性患者。开展本项目旨在基于前列腺腺癌患者标准检查期间常规获得的临床参数，开发一种能够预测根治性前列腺切除术后长期预后的分期系统。
对1989年至1996年间因前列腺腺癌接受根治性耻骨后前列腺切除术的688例临床局限性前列腺癌患者进行评估，采用Cox回归多变量分析预测前列腺特异性抗原（PSA）失败时间的临床特征。评估了一种最近定义的称为计算前列腺癌体积的临床因素及其与PSA、活检Gleason评分和临床分期联合预测PSA失败时间的能力。
计算前列腺癌体积（p<0.0001）和术前PSA（p<0.001）为预测根治性前列腺切除术后无PSA失败提供了最佳分期系统。
计算前列腺癌体积和PSA可为根治性前列腺切除术后的预后提供临床有用信息，从而为临床局限性疾病的个体患者选择治疗方法。需要对该分期系统进行验证。
