The influence of the presence of intraductal carcinoma of the prostate on the grade group system's prognostic performance
The influence of the presence of intraductal carcinoma of the prostate on the grade group system's prognostic performance
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DOI：
10.1002/pros.23818
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发表时间：
2019-07-01
期刊：
影响因子：
2.8
通讯作者：
Tsuzuki, Toyonori
中科院分区：
文献类型：
--
作者：
Kato, Masashi;Hirakawa, Akihiro;Tsuzuki, Toyonori
背景：尽管前列腺癌(IDC-P)的存在会影响前列腺癌根治术患者的生化衰竭，但目前还没有关于其与分级分级系统整合的影响的数据。因此，本研究的目的是通过整合IDC-P的存在来提高年级组系统的实用性。方法对2005-2013年间接受根治性前列腺癌切除术的1019例前列腺癌患者进行回顾性分析。分析年龄、诊断时前列腺特异性抗原(PSA)水平、病理T分期(PT)、Gleason模式5(GP5)、IDC-P和手术切缘状况等资料，以预测前列腺癌切除术后PSA复发。结果患者年龄中位数67岁(45~80岁)，初诊PSA中位数6.8(0.4~82)ng/mL。中位随访期82个月(0.7~148个月)。共检出IDC-P 157例(15.4%)。在这些患者中，IDC-P阳性率的增加与肿瘤升级有关。年级组如下：GG1无IDC-P，16.0%(n=163)；GG2无IDC-P，46.1%(n=470)；GG3无IDC-P，15.7%(n=160)；GG4无IDC-P，2.6%(n=27)；GG5无IDC-P，4.1%(n=42)；GG4(n=13)；GG5(n=55)]。有IDC-P的任何分级组的预后均明显差于任何其他无IDC-P的组(P<；0.0001)。在多变量分析中，IDC-P分级组的积分、确诊时的PSA水平和手术切缘状况是显著的预后预测因素(分别为P<；0.0001、P<；0.0001和P<；0.0001)。结论将IDC-P的存在整合到分级分组系统中将导致对患者结果的更准确的预测。
Background Although the presence of intraductal carcinoma of the prostate (IDC-P) influences biochemical failure in radical prostatectomy patients, no data are available regarding the impact of its integration into the classification grade group system. Thus, the aim of this study was to enhance the utility of the grade group system by integrating the presence of IDC-P. Methods This study was a retrospective evaluation of 1019 patients with prostate cancer who underwent radical prostatectomy between 2005 and 2013 without neoadjuvant or adjuvant therapy. The data on age, prostate-specific antigen (PSA) level at diagnosis, pathological T stage (pT), presence of Gleason pattern 5 (GP5), presence of IDC-P, and surgical margin status were analyzed to predict PSA recurrence after prostatectomy. Results The median patient age was 67 (range, 45-80) years and the median initial PSA level was 6.8 (range, 0.4-82) ng/mL. The median follow-up period was 82 (range, 0.7-148) months. IDC-P was detected in 157 patients (15.4%). Among these patients, the increase in the positive rate of IDC-P correlated with tumor upgrading. The grade groups (GGs) were as follows: GG1 without IDC-P, 16.0% (n = 163); GG2 without IDC-P, 46.1% (n = 470); GG3 without IDC-P, 15.7% (n = 160); GG4 without IDC-P, 2.6% (n = 27); GG5 without IDC-P, 4.1% (n = 42); any GG with IDC-P, 15.4% [n = 157; GG 2 (n = 29); GG3 (n = 60); GG4 (n = 13); GG5 (n = 55)]. Any grade Group with IDC-P showed significantly worse prognosis than any other group without IDC-P (P < 0.0001). In a multivariate analysis, integration of the IDC-P into the Grade Groups, the PSA level at diagnosis, and the surgical margin status were significant prognostic predictors (P < 0.0001, < 0.0001 and < 0.0001, respectively). Conclusions Integrating the presence of IDC-P into the grade group system will result in more accurate predictions of patient outcome.