Prostate Cancer-Specific Mortality After Radical Prostatectomy for Patients Treated in the Prostate-Specific Antigen Era
Prostate Cancer-Specific Mortality After Radical Prostatectomy for Patients Treated in the Prostate-Specific Antigen Era
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DOI：
10.1200/jco.2008.18.2501
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发表时间：
2009-09-10
影响因子：
45.3
通讯作者：
Scardino, Peter T.
中科院分区：
文献类型：
--
作者：
Stephenson, Andrew J.;Kattan, Michael W.;Scardino, Peter T.
目的在前列腺特异性抗原（PSA）广泛筛查的时代，根治性前列腺切除术后前列腺癌特异性死亡率（PCSM）的长期风险尚不明确。患者咨询和临床试验设计需要预测PCSM风险的模型。方法对1987年至2005年接受根治性前列腺切除术的12677例患者进行多机构队列分析，分析其发生PCSM的风险。采用Fine和Gray竞争风险回归分析对患者临床信息和治疗结果进行建模，预测PCSM。结果15年PCSM和全因死亡率分别为12%和38%。根据流行的nomogram，在psa定义的预测复发风险的最低和最高四分位数的患者中，估计的PCSM范围从5%到38%。活检Gleason分级、PSA和手术年份与PCSM相关。建立了预测15年PCSM风险的nomogram，外部验证的一致性指数为0.82。术前PSA速度和体重指数均不能提高模型的准确性。只有4%的当代患者预测15年的PCSM大于5%。结论在根治性前列腺切除术后的15年内，很少有患者死于前列腺癌，尽管存在不良临床特征。这种良好的预后可能与根治性前列腺切除术的有效性（有或没有二次治疗）或筛查检测到的癌症的低致死率有关。鉴于仅根据临床特征识别PCSM风险显著升高的当代患者的能力有限，显然需要与致死性前列腺癌生物学特异性相关的新型标志物。
PurposeThe long-term risk of prostate cancer-specific mortality (PCSM) after radical prostatectomy is poorly defined for patients treated in the era of widespread prostate-specific antigen (PSA) screening. Models that predict the risk of PCSM are needed for patient counseling and clinical trial design.MethodsA multi-institutional cohort of 12,677 patients treated with radical prostatectomy between 1987 and 2005 was analyzed for the risk of PCSM. Patient clinical information and treatment outcome was modeled using Fine and Gray competing risk regression analysis to predict PCSM.ResultsFifteen-year PCSM and all-cause mortality were 12% and 38%, respectively. The estimated PCSM ranged from 5% to 38% for patients in the lowest and highest quartiles of predicted risk of PSA-defined recurrence, based on a popular nomogram. Biopsy Gleason grade, PSA, and year of surgery were associated with PCSM. A nomogram predicting the 15-year risk of PCSM was developed, and the externally validated concordance index was 0.82. Neither preoperative PSA velocity nor body mass index improved the model's accuracy. Only 4% of contemporary patients had a predicted 15-year PCSM of greater than 5%.ConclusionFew patients will die from prostate cancer within 15 years of radical prostatectomy, despite the presence of adverse clinical features. This favorable prognosis may be related to the effectiveness of radical prostatectomy (with or without secondary therapy) or the low lethality of screen-detected cancers. Given the limited ability to identify contemporary patients at substantially elevated risk of PCSM on the basis of clinical features alone, the need for novel markers specifically associated with the biology of lethal prostate cancer is evident.