Oncological and peri-surgical outcomes of radical prostatectomy for non-metastatic prostate cancer with prostate-specific antigen level of 50 ng/ml or greater
Oncological and peri-surgical outcomes of radical prostatectomy for non-metastatic prostate cancer with prostate-specific antigen level of 50 ng/ml or greater
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前列腺特异性抗原水平为 50 ng/ml 或更高的非转移性前列腺癌根治性前列腺切除术的肿瘤学和围手术期结果
DOI：
10.1093/jjco/hyy044
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发表时间：
2018
影响因子：
2.4
通讯作者：
Homma Yukio
中科院分区：
文献类型：
--
作者：
Makino Katsuhiro;Nakagawa Tohru;Ito Eisaku;Kasahara Ichiro;Murata Takashi;Fujimura Tetsuya;Fukuhara Hiroshi;Homma Yukio
背景根治性前列腺切除术在治疗高前列腺特异性抗原水平的非转移性前列腺癌患者中的作用尚不清楚。我们评估了前列腺特异性抗原水平为50 ng/ml或更高的非转移性前列腺癌患者行根治性前列腺切除术的可行性和肿瘤学结局。（任何T的临床阶段，N 0 -1 M0和PSA水平≥50 ng/ml），并接受根治性直肠癌切除术作为单药治疗或作为多模式治疗的组成部分（RP组）。研究了手术相关并发症。采用Kaplan-Meier方法估计至去势抵抗性前列腺癌的时间、癌症特异性生存期和总生存期。对照组为47例接受雄激素阻断治疗而未接受局部治疗的极高危前列腺癌患者（ADT组）。RP组和ADT组的探索性analysis.ResultsThe中位数预处理前列腺特异性抗原为87 ng/ml和100 ng/ml的RP和ADT组，分别（P= 0.67）。9名患者（29%）记录了Clavien-Dindo 3级手术并发症。RP组10年去势抵抗前列腺无癌生存率、肿瘤特异性生存率和总生存率分别为78%、81%和77%，均明显优于ADT组（54%，P = 0.006; 54%，P = 0.006和38%，P < 0.001）。探索性多因素分析显示根治性直肠癌切除术是与较好的癌症特异性生存率相关的唯一显著因素（风险比：0.25，P = 0.006）。根治性前列腺切除术是一个可行的选择，选择非转移性，非常高风险的前列腺癌患者。
BackgroundThe role of radical prostatectomy in treating non-metastatic prostate cancer patients with high prostate-specific antigen levels remains unclear. We evaluated the feasibility and oncological outcomes of radical prostatectomy in non-metastatic prostate cancer patients with prostate-specific antigen levels of 50 ng/ml or higher.MethodsThis retrospective study included 31 patients who were diagnosed as very high-risk prostate cancer (clinical stage of any T, N0-1 M0 and PSA levels ≥50 ng/ml) and underwent radical prostatectomy either as a monotherapy or as a component of multimodal therapy (RP group). Surgery-related complications were investigated. Time to castration-resistant prostate cancer, cancer-specific survival, and overall survival were estimated using the Kaplan–Meier method. A total of 47 patients with very high-risk prostate cancer who were treated with androgen deprivation therapy without local therapy served as a control group (ADT group). Survivals were compared between RP group and ADT group in exploratory analyses.ResultsThe median pretreatment prostate-specific antigen was 87 ng/ml and 100 ng/ml in the RP and ADT groups, respectively (P= 0.67). Surgical complications of Clavien-Dindo Grade 3 were documented in nine patients (29%). Ten-year castration-resistant prostate cancer-free, cancer-specific and overall survivals were 78%, 81% and 77% in RP group, respectively, and they were significantly better than those of ADT group (54%,P= 0.006; 54%,P= 0.006 and 38%,P< 0.001). Exploratory multivariate analysis identified radical prostatectomy as the only significant factor associated with a better cancer-specific survival (hazard ratio: 0.25,P= 0.006).ConclusionsRadical prostatectomy is feasible for non-metastatic prostate cancer patients with prostate-specific antigen levels of 50 ng/ml or higher. Radical prostatectomy is a viable option for select patients with non-metastatic, very high-risk prostate cancer.