Radical prostatectomy for clinically localized, high risk prostate cancer: Critical analysis of risk assessment methods
Radical prostatectomy for clinically localized, high risk prostate cancer: Critical analysis of risk assessment methods
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DOI：
10.1016/j.juro.2007.03.105
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发表时间：
2007-08-01
影响因子：
6.6
通讯作者：
Eastham, James A.
中科院分区：
文献类型：
--
作者：
Yossepowitch, Ofer;Eggener, Scott E.;Eastham, James A.
目的：在确定性治疗之前，缺乏标准化的标准来定义高危的、临床上局限的前列腺癌。依赖简单的风险分层方案来定义高危癌症导致许多医生和患者走向治疗虚无主义，不适当地选择雄激素剥夺而不是确定的局部治疗。在接受根治性直肠癌切除术的患者中，我们根据先前描述的8个定义确定了高危患者。我们研究的病理特征和前列腺特异性抗原outcomes.Materials和Methods：研究人群包括4,708例男性根治性前列腺切除术治疗1985年至2004年之间。采用Kaplan-Meier法对高危患者的前列腺特异性抗原复发进行估计。考克斯比例风险回归被用来估计高风险与非高风险cohols.Results：根据使用的定义，在高风险的患者组成的研究人群的3%至38%的复发率。在男性高危癌患者中，囊外侵犯、精囊侵犯和淋巴结转移的比例分别为35%~ 71%、10%~ 33%和7%~ 23%。在高危肿瘤中，22%至63%的肿瘤病理证实局限于前列腺。虽然高危患者前列腺特异性抗原复发的风险增加了1.8至4.8倍，但单纯根治性前列腺切除术后5年无复发概率为49%（95%CI 39至58）至80%（95%CI 77至83）。在高风险的患者复发25%，在所有的定义经历了复发超过2年后手术，并在26%至39%的前列腺特异性抗原倍增时间在复发10个月或更长的。结论：目前可用的定义诊断为高风险癌症的患者根治性前列腺切除术后没有一个统一的预后不良。许多临床上被归类为高风险的癌症实际上在病理上局限于前列腺。前列腺外疾病和前列腺特异性抗原复发的风险根据所使用的定义有很大差异。
Purpose: Standardized criteria are lacking to define high risk, clinically localized prostate cancer before definitive treatment. Reliance on simple risk stratification schemes to define high risk cancers has led many physicians and patients toward therapeutic nihilism, inappropriately selecting androgen deprivation instead of definitive local therapy. Of patients undergoing radical prostatectomy we identified those at high risk based on 8 previously described definitions. We examined pathological characteristics and prostate specific antigen outcomes.Materials and Methods: The study population included 4,708 men treated with radical prostatectomy alone between 1985 and 2004. Estimates of prostate specific antigen relapse for patients at high risk were generated with the Kaplan-Meier method. Cox proportional hazards regression was used to estimate the HR for recurrence in high risk vs nonhigh risk cohorts.Results: Depending on the definition used patients at high risk composed 3% to 38% of the study population. The proportion of patients with extracapsular extension, seminal vesicle invasion and lymph node metastasis among men with high risk cancer was 35% to 71%, 10% to 33% and 7% to 23%, respectively. Of the high risk tumors 22% to 63% proved to be confined to the prostate pathologically. While patients at high risk had a 1.8 to 4.8-fold increased hazard of prostate specific antigen relapse, their 5-year relapse-free probability after radical prostatectomy alone was 49% (95% CI 39 to 58) to 80% (95% CI 77 to 83). Of patients at high risk who had relapse 25% across all definitions experienced relapse more than 2 years after surgery and in 26% to 39% prostate specific antigen doubling time at recurrence was 10 months or greater.Conclusions: Patients diagnosed with high risk cancer by currently available definitions do not have a uniformly poor prognosis after radical prostatectomy. Many cancers classified clinically as high risk are actually confined to the prostate pathologically. The risk of extraprostatic disease and prostate specific antigen relapse varies greatly depending on the definition used.