Very-high-risk localized prostate cancer: definition and outcomes.
Very-high-risk localized prostate cancer: definition and outcomes.
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DOI：
10.1038/pcan.2013.46
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发表时间：
2014-03
影响因子：
4.8
通讯作者：
Ross, A. E.
中科院分区：
文献类型：
--
作者：
Sundi, D.;Wang, V. M.;Pierorazio, P. M.;Han, M.;Bivalacqua, T. J.;Ball, M. W.;Antonarakis, E. S.;Partin, A. W.;Schaeffer, E. M.;Ross, A. E.
患有NCCN高危前列腺癌(PCA)的男性患者的结果可能有很大不同--一些人将具有出色的癌症特有的存活率，而另一些人即使在积极的局部治疗后也会经历早期转移。目前的诺模图产生了连续的风险概率，并没有将高风险的主成分分析分成不同的子层。在这里，我们推导出极高风险(VHR)局部性PCA的二元定义，以帮助在诊断和治疗选择时进行风险分层。我们查询约翰霍普金斯根治性前列腺切除术数据库，确定了753名患有NCCN高危局限性前列腺癌(Gleason sum 8-10，PSA>；20 ng/ml，或临床期≥T3)的男性。28个不良分级、分期和肿瘤体积的交替排列通过其转移和癌症特异性死亡率的风险比进行了比较。具有最高风险比的VHR标准通过多变量分析和纳入临床上有意义的高危队列比例进一步评估。VHR队列的最佳定义是活检中出现的主要模式5，或Gleason sum 8-10的≥5核心，或多个NCCN高危特征。这些标准涵盖了NCCN高危队列的15.1%。与其他高危男性相比，VHR男性的转移风险(H.R.2.75)和癌症特异性死亡率(H.R.3.44)显著更高(P<；两者均为0.001)。在高危男性中，VHR男性的10年无转移生存率(37%对78%)和癌症特异性生存率(62%对90%)也明显较差。符合VHR标准的男性在目前的NCCN高危分类中形成了一个亚组，他们的肿瘤学结果特别差。使用这些特征来区分VHR局部性PCA可能有助于咨询和选择多模式治疗或临床试验的最佳候选者。
Outcomes in men with NCCN high-risk prostate cancer (PCa) can vary substantially--some will have excellent cancer-specific survival, whereas others will experience early metastasis even after aggressive local treatments. Current nomograms, which yield continuous risk probabilities, do not separate high-risk PCa into distinct sub-strata. Here we derive a binary definition of very-high-risk (VHR) localized PCa to aid in risk stratification at diagnosis and selection of therapy. We queried the Johns Hopkins radical prostatectomy database to identify 753 men with NCCN high-risk localized PCa (Gleason sum 8–10, PSA >20 ng/ml, or clinical stage ≥T3). 28 alternate permutations of adverse grade, stage, and cancer volume were compared by their hazard ratios for metastasis and cancer-specific mortality. VHR criteria with top-ranking hazard ratios were further evaluated by multivariable analyses and inclusion of a clinically meaningful proportion of the high-risk cohort. The VHR cohort was best defined by primary pattern 5 present on biopsy, or ≥5 cores with Gleason sum 8–10, or multiple NCCN high-risk features. These criteria encompassed 15.1% of the NCCN high-risk cohort. Compared to other high-risk men, VHR men were at significantly higher risk for metastasis (H.R. 2.75) and cancer-specific mortality (H.R. 3.44) (p <0.001 for both). Among high-risk men, VHR men also had significantly worse 10-year metastasis-free survival (37% vs 78%) and cancer-specific survival (62% vs 90%). Men who meet VHR criteria form a subgroup within the current NCCN high-risk classification who have particularly poor oncologic outcomes. Use of these characteristics to distinguish VHR localized PCa may help in counseling and selection optimal candidates for multimodal treatments or clinical trials.
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影响因子：
4.5
作者：
Pierorazio PM;Ross AE;Han M;Epstein JI;Partin AW;Schaeffer EM
通讯作者：
Schaeffer EM
影响因子：
6.6
作者：
Moul, JW;Wu, HY;Soderdahl, D
通讯作者：
Soderdahl, D
影响因子：
45.3
作者：
D'Amico, AV;Moul, J;Chen, MH
通讯作者：
Chen, MH
DOI：
10.6004/jnccn.2010.0015
发表时间：
2010-02-01
影响因子：
13.4
作者：
Nielsen, Matthew E.;Trock, Bruce J.;Walsh, Patrick C.
通讯作者：
Walsh, Patrick C.
影响因子：
11.5
作者：
Slovin, SF;Wilton, AS;Scher, HI
通讯作者：
Scher, HI