Validation of TNM classification for metastatic prostatic cancer treated using primary androgen deprivation therapy
Validation of TNM classification for metastatic prostatic cancer treated using primary androgen deprivation therapy
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DOI：
10.1007/s00345-015-1607-3
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发表时间：
2016-02-01
影响因子：
3.4
通讯作者：
Namiki, Mikio
中科院分区：
文献类型：
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作者：
Kadono, Yoshifumi;Nohara, Takahiro;Namiki, Mikio
目前的肿瘤-淋巴结-转移(TNM)分类系统已被使用多年。从日本前列腺癌研究小组数据库中选取转移性前列腺癌(MPC)患者5618例，其中单纯淋巴结转移(N1M0)、非区域淋巴结转移(M1a)、骨转移(M1b)、远处转移(M1c)。采用Kaplan-Meier分析计算总生存率(OS)、肿瘤特异性生存率(CS)和无进展生存率(PFS)。N1M0、M1a、M1a、M1b、M1c的5年OS、CS、PFS分别为76.0%、83.2%、38.8%、57.5%、69.0%、23.0%、54.0%、63.1%、23.0%、40.0%、51.5%、16.6%。OS、CS和PFS随着阶段的进展而恶化。与N0M1b相比，N1M1b的OS、CSS和PFS均显著更差。多变量分析显示，Gleason评分为千分之八的患者的OS和CS较差，而联合雄激素阻断(CAB)治疗在任何肿瘤阶段都比非CAB治疗提供更好的OS。然而，仅在M1b中具有前列腺特异性抗原>；100 ng/ml的个体的OS和CS更差。随着分期的进展，患者的预后恶化；因此，目前的MPC PADT的TNM分类系统是可靠的。每一个发生骨转移或淋巴转移的PC细胞可能表现出不同的特征。
The current tumor-node-metastasis (TNM) classification system has been used for many years. The prognosis of patients with metastatic prostate cancer (mPC) treated using primary androgen deprivation therapy (PADT) was analyzed according to the TNM classification.A total of 5618 cases with lymph node metastases only (N1M0), non-regional lymph node metastasis (M1a), bone metastasis (M1b), and distant metastasis (M1c) were selected from the Japanese Study Group of Prostate Cancer database. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) rates were calculated using Kaplan-Meier analysis. The influence of clinical variables on patient prognosis was evaluated using the Cox proportional hazard regression model.The 5-year OS, CSS, and PFS were 76.0, 83.2, and 38.8 % in N1M0, 57.5, 69.0, and 23.0 % in M1a, 54.0, 63.1, and 23.0 % in M1b, and 40.0, 51.5, and 16.6 % in M1c, respectively. OS, CSS, and PFS worsened as the stages progressed. OS, CSS, and PFS were all significantly worse in N1M1b compared with N0M1b. Multivariate analysis revealed that OS and CSS were worse in patients with a Gleason score a parts per thousand yen8 and that combined androgen blockade (CAB) treatment provided better OS than non-CAB treatments at any tumor stage. However, OS and CSS were worse in individuals with a prostate-specific antigen > 100 ng/ml only in M1b.Patient prognosis worsened with stage progression; therefore, current TNM classification system of mPC for PADT was shown to be trustworthy. Each PC cell that develops bone or lymphoid metastasis may exhibit different characteristics.