Improved risk stratification for biochemical recurrence after radical prostatectomy using a novel risk group system based on prostate specific antigen density and biopsy Gleason score
Improved risk stratification for biochemical recurrence after radical prostatectomy using a novel risk group system based on prostate specific antigen density and biopsy Gleason score
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DOI：
10.1016/s0022-5347(05)64841-0
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发表时间：
2002-07-01
影响因子：
6.6
通讯作者：
Aronson, WJ
中科院分区：
文献类型：
--
作者：
Freedland, SJ;Wieder, JA;Aronson, WJ
目的：先前的研究表明，前列腺特异性抗原（PSA）密度是主要治疗后生化失败的重要独立预测因子。我们使用根治性前列腺切除术标本的手术重量确定病理 PSA 密度是否是根治性前列腺切除术后不良病理特征或生化复发的独立预测因子。我们还检查了与血清 PSA 和活检格里森评分相比，将病理 PSA 密度与活检格里森评分相结合是否可以改善预测前列腺切除术后 PSA 复发的风险分层。材料和方法：使用多变量分析来确定病理 PSA 密度是否是退伍军人事务部医疗中心治疗的 325 名患者根治性前列腺切除术后不良病理或 PSA 复发的独立预测因子。生成病理 PSA 密度的截止点，以识别具有各种生化复发风险的患者。这些截止点与活检格里森截止点 2 至 6、7 和 8 至 10 相结合，生成风险分层系统，并与之前使用 PSA 和活检格里森评分截止点的风险分层系统进行比较。在另一组由 490 名在三级医疗中心接受根治性前列腺切除术的患者组成的队列中，评估了使用病理 PSA 密度和活检格里森评分的风险分层系统的有效性。结果：病理 PSA 密度是阳性手术切缘 (p < 0.001)、非器官局限性疾病 (p < 0.001)、精囊侵犯 (p = 0.003) 和根治术后生化复发的独立预测因子前列腺切除术（p < 0.001）。病理性 PSA 密度的截止点为小于 0.3、0.3 至 0.7 和大于 0.7 ng./ml./gm。将患者分为 3 个不同的组，根治性前列腺切除术后生化失败的风险增加（p < 0.001）。在退伍军人事务部（风险比 3.04，置信区间 2.25 至 4.11，p < 0.001）和三级护理（风险比）治疗的患者中，病理 PSA 密度临界值与活检格里森评分临界值 2 至 6、7 和 8 至 10 相结合，比基于 PSA 和活检格里森评分组合的临界值提供了更好的生化失败风险分层。 2.38，置信区间 1.78 至 3.18，p < 0.001）医疗中心。结论：病理 PSA 密度是根治性前列腺切除术后晚期病理和生化失败的有力预测因子。病理 PSA 密度与活检格里森评分相结合定义了一种新的风险组系统，与 PSA 和活检格里森评分的组合相比，该系统改善了风险分层。这些结果在三级医疗中心接受根治性前列腺切除术的另一组患者中得到了验证。需要使用术前经直肠超声测量计算出的 PSA 密度值进行进一步研究，以确定 PSA 密度和活检格里森评分的组合是否可以提供显着的治疗前风险分层。
Purpose: Previous studies have suggested that prostate specific antigen (PSA) density is a significant independent predictor of biochemical failure after primary therapy. We determined whether pathological PSA density using surgical weight of the radical prostatectomy specimen was an independent predictor of adverse pathological features or biochemical recurrence after radical prostatectomy. We also examined whether combining pathological PSA density with biopsy Gleason score improved risk stratification compared with serum PSA and biopsy Gleason score for predicting PSA recurrence after prostatectomy.Materials and Methods: Multivariate analysis was used to determine whether pathological PSA density was an independent predictor of adverse pathology or PSA recurrence after radical prostatectomy in 325 patients treated at a Veterans Affairs medical center. Cutoff points of pathological PSA density were generated to identify patients at various risks for biochemical recurrence. These cutoffs were combined with biopsy Gleason cutoff points 2 to 6, 7 and 8 to 10 to generate a risk stratification system that was compared with a previous risk stratification system using PSA and biopsy Gleason score cutoff points. The validity of the risk stratification system using pathological PSA density and biopsy Gleason score was evaluated in another cohort of 490 patients treated with radical prostatectomy at a tertiary care medical center.Results: Pathological PS A density was an independent predictor of positive surgical margins (p < 0.001), nonorgan confined disease (p < 0.001), seminal vesicle invasion (p = 0.003) and biochemical recurrence after radical prostatectomy (p < 0.001). The cutoff points for pathological PSA density of less than 0.3, 0.3 to 0.7 and greater than 0.7 ng./ml./gm. separated patients into 3 distinct groups at increasing risk for biochemical failure after radical prostatectomy (p < 0.001). Pathological PSA density cutoffs combined with biopsy Gleason score cutoffs 2 to 6, 7 and 8 to 10 provided better risk stratification for biochemical failure than cutoffs based on a combination of PSA and biopsy Gleason score in patients treated at the Veterans Affairs (hazards ratio 3.04, confidence interval 2.25 to 4.11, p < 0.001) and tertiary care (hazards ratio 2.38, confidence interval 1.78 to 3.18, p < 0.001) medical centers.Conclusions: Pathological PSA density was a strong predictor of advanced pathology and biochemical failure after radical prostatectomy. Pathological PSA density combined with biopsy Gleason score defined a novel risk group system that improved risk stratification compared with a combination of PSA and biopsy Gleason score. These results were validated in another cohort of patients treated with radical prostatectomy at a tertiary care medical center. Further studies are required using PSA density values calculated from preoperative transrectal ultrasound measurements to determine whether a combination of PSA density and biopsy Gleason score provides significant pretreatment risk stratification.