D'Amico A V, Desjardin A, Chen M H, Paik S, Schultz D, Renshaw A A, Loughlin K R, Richie J P
Joint Center for Radiation Therapy, Harvard Medical School, Boston, Massachusetts 02215, USA.
Cancer. 1998 Nov 15;83(10):2172-80. doi: 10.1002/(sici)1097-0142(19981115)83:10<2172::aid-cncr16>3.0.co;2-k.
A clinical staging system based on the prostate-specific antigen (PSA) and the calculated prostate carcinoma volume (cVCa) construct previously has been proposed. This study was performed to assess whether this proposed clinical staging system was valid in an independent surgical and radiation data set in patients with clinically localized disease.
Cox regression multivariable analyses were used to assess the significance of staging systems (1992 American Joint Commission on Cancer Staging [AJCC] clinical and pathologic stage, versus cVCa-PSA clinical stage) to predict time to posttherapy PSA failure in 441 and 465 patients managed by surgery and radiation, respectively. Significant staging systems identified using Cox regression were tested further using established comparative measures to define the most clinically useful system.
Both the 1992 AJCC pathologic stage and the cVCa-PSA clinical stage were significant predictors of time to postoperative PSA failure (P = 0.0001), whereas only the cVCa-PSA clinical stage was a significant predictor of time to postradiation PSA failure (P = 0.0001) using a Cox regression multivariable analysis. Further analyses using a pairwise comparison of the 1992 AJCC pathologic stage and cVCa-PSA clinical stage found the cVCa-PSA staging system provided a more clinically useful prediction of time to postoperative PSA failure. Specifically, the cVCa-PSA staging system was able to identify surgically managed patients with pathologic AJCC T2 disease who did poorly (3-year bNED = 22%) while also selecting patients with clinical AJCC T2b,c disease that was managed by radiation who did well (3-year bNED = 100%).
A clinical staging system based on parameters obtained during the routine evaluation for AJCC clinical T1,2 prostate carcinoma provided a clinically useful stratification of both postoperative and postradiation PSA failure free survival.
先前已提出一种基于前列腺特异性抗原（PSA）和计算得出的前列腺癌体积（cVCa）构建的临床分期系统。本研究旨在评估该提议的临床分期系统在临床局限性疾病患者的独立手术和放疗数据集中是否有效。
采用Cox回归多变量分析来评估分期系统（1992年美国癌症联合委员会[AJCC]临床和病理分期，与cVCa-PSA临床分期）对分别接受手术和放疗的441例和465例患者治疗后PSA失败时间的预测意义。使用既定的比较指标对通过Cox回归确定的重要分期系统进行进一步测试，以确定最具临床实用性的系统。
使用Cox回归多变量分析，1992年AJCC病理分期和cVCa-PSA临床分期均是术后PSA失败时间的显著预测因素（P = 0.0001），而只有cVCa-PSA临床分期是放疗后PSA失败时间的显著预测因素（P = 0.0001）。对1992年AJCC病理分期和cVCa-PSA临床分期进行成对比较的进一步分析发现，cVCa-PSA分期系统对术后PSA失败时间的预测在临床上更具实用性。具体而言，cVCa-PSA分期系统能够识别出病理AJCC T2期疾病且手术治疗效果不佳的患者（3年无生化复发生存率 = 22%），同时也能筛选出接受放疗且临床AJCC T2b、c期疾病治疗效果良好的患者（3年无生化复发生存率 = 100%）。
基于AJCC临床T1、2期前列腺癌常规评估中获得的参数建立的临床分期系统，对术后和放疗后无PSA失败生存期进行了具有临床实用性的分层。
