Importance of prostate volume in the stratification of patients with intermediate-risk prostate cancer
Importance of prostate volume in the stratification of patients with intermediate-risk prostate cancer
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DOI：
10.1111/iju.12748
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发表时间：
2015-06-01
影响因子：
2.6
通讯作者：
Briganti, Alberto
中科院分区：
文献类型：
--
作者：
Moschini, Marco;Gandaglia, Giorgio;Briganti, Alberto
目的 评估最终病理学评估的前列腺体积在接受根治性前列腺切除术治疗的临床局限性前列腺癌患者生化复发风险中的作用。方法总共确定了 1993 年 1 月至 2013 年 8 月期间接受根治性前列腺切除术治疗的 5637 例患者。多变量 Cox 回归分析测试了总体人群中以及根据 D'Amico 风险组对患者进行分层后前列腺体积与生化复发之间的关联。结果平均（中位）前列腺体积为 50.61mL (46mL)。当患者根据 D'Amico 风险组进行分层时，低风险、中风险和高风险前列腺癌的平均（中位）前列腺体积分别为 51.7mL（48mL）、49.8mL（45mL）和 50.6mL（46mL）（P=0.04）。总体而言，5年生化无复发生存率为87.9%。在多变量 Cox 回归分析中，考虑到疾病特征后，前列腺体积与较低的生化复发风险相关（风险比 0.99，95% 置信区间 0.99-1.00）。然而，当根据 D'Amico 风险组对患者进行分层时，前列腺体积仅在患有中等风险疾病的个体中代表生化复发的独立预测因子（风险比 0.99，95% 置信区间 0.99-1.00）。相反，前列腺体积与低风险和高风险疾病患者的生化复发风险无关。结论 仅在患有中等风险疾病的男性中，较小的前列腺与手术后生化复发风险增加相关。在这一类别中，术前前列腺体积评估可能有助于识别术后生化复发风险较高的患者。此外，前列腺体积可用于制定根治性前列腺切除术后的个体化随访计划。
ObjectivesTo evaluate the role of prostate volume assessed at final pathology in the risk of biochemical recurrence in patients with clinically localized prostate cancer treated with radical prostatectomy.MethodsOverall, 5637 patients treated with radical prostatectomy between January 1993 and August 2013 were identified. Multivariable Cox regression analyses tested the association between prostate volume and biochemical recurrence in the overall population and after stratifying patients according to the D'Amico risk groups.ResultsMean (median) prostate volume was 50.61mL (46mL). When patients were stratified according to D'Amico risk groups, mean (median) prostate volume was 51.7mL (48mL), 49.8mL (45mL) and 50.6mL (46mL) in low-, intermediate-, and high-risk prostate cancer, respectively (P=0.04). Overall, the 5-year biochemical recurrence-free survival rate was 87.9%. In multivariable Cox regression analyses, prostate volume was associated with a lower risk of biochemical recurrence (hazard ratio 0.99, 95% confidence interval 0.99-1.00), after accounting for disease characteristics. However, when patients were stratified according to D'Amico risk groups, prostate volume represented an independent predictor of biochemical recurrence only in individuals with intermediate-risk disease (hazard ratio 0.99, 95% confidence interval 0.99-1.00). Conversely, prostate volume was not associated with the risk of experiencing biochemical recurrence in patients with low- and high-risk disease.ConclusionsSmaller prostates are associated with increased risk of biochemical recurrence after surgery only in men with intermediate-risk disease. In this category, the preoperative assessment of prostate volume might be helpful in order to identify patients at higher risk of biochemical recurrence after surgery. Additionally, prostate volume might be used to individualize follow-up schedules after radical prostatectomy.