Predicting 15-year prostate cancer specific mortality after radical prostatectomy.
Predicting 15-year prostate cancer specific mortality after radical prostatectomy.
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DOI：
10.1016/j.juro.2010.10.057
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发表时间：
2011-03
期刊：
影响因子：
--
通讯作者：
Stephenson AJ
中科院分区：
文献类型：
--
作者：
Eggener SE;Scardino PT;Walsh PC;Han M;Partin AW;Trock BJ;Feng Z;Wood DP;Eastham JA;Yossepowitch O;Rabah DM;Kattan MW;Yu C;Klein EA;Stephenson AJ
在广泛筛查的时代，根治性前列腺切除术后的长期前列腺癌特异性死亡率（PCSM）定义不明确。治疗决策需要了解筛查检测癌症的治疗自然史和PCSM的病理风险因素。使用Fine和Gray竞争风险回归分析，对1987年至2005年在四个学术中心接受根治性直肠癌切除术的11，521例患者的临床和病理数据以及随访信息进行建模，以预测PCSM。该模型在同一时期在一个单独的机构接受治疗的12，389名患者中进行了验证。总体15年PCSM为7%。原发性和继发性病理Gleason分级4-5级（两者P < 0.001）、精囊浸润（P < 0.001）和手术年（P = 0.002）是PCSM的重要预测因素。基于标准病理学参数预测15年PCSM的列线图是准确的，并具有外部验证的一致性指数0.92。按患者年龄分层，Gleason评分≤ 6、3+4、4+3和8-10的15年PCSM范围分别为0.2- 1.2%、4.2- 6.5%、6.6- 11%和26- 37%。15年PCSM的风险范围分别为0.8- 1.5%、2.9- 10%、15- 27%和22-30%，包括器官局限性癌、前列腺外浸润、精囊浸润和淋巴结转移。在9557例器官受限、Gleason评分≤ 6的癌症患者中，仅有3例死于前列腺癌。低分化癌和精囊侵犯是决定前列腺癌根治术后PCSM的主要因素。一旦了解前列腺癌的病理特征，就可以以前所未有的准确度预测PCSM的风险。
Long-term prostate cancer-specific mortality (PCSM) after radical prostatectomy is poorly defined in the era of widespread screening. An understanding of the treated natural history of screen-detected cancers and the pathological risk factors for PCSM are needed for treatment decision-making. Using Fine and Gray competing risk regression analysis, the clinical and pathological data and follow-up information of 11,521 patients treated by radical prostatectomy at four academic centers from 1987 to 2005 were modeled to predict PCSM. The model was validated on 12,389 patients treated at a separate institution during the same period. The overall 15-year PCSM was 7%. Primary and secondary pathological Gleason grade 4–5 (P < 0.001 for both), seminal vesicle invasion (P < 0.001), and year of surgery (P = 0.002) were significant predictors of PCSM. A nomogram predicting 15-year PCSM based on standard pathological parameters was accurate and discriminating with an externally-validated concordance index of 0.92. Stratified by patient age, 15-year PCSM for Gleason score ≤ 6, 3+4, 4+3, and 8–10 ranged from 0.2–1.2%, 4.2–6.5%, 6.6–11%, and 26–37%, respectively. The 15-year PCSM risks ranged from 0.8–1.5%, 2.9–10%, 15–27%, and 22–30% for organ-confined cancer, extraprostatic extension, seminal vesicle invasion, and lymph node metastasis, respectively. Only 3 of 9557 patients with organ-confined, Gleason score ≤ 6 cancers have died from prostate cancer. The presence of poorly differentiated cancer and seminal vesicle invasion are the prime determinants of PCSM after radical prostatectomy. The risk of PCSM can be predicted with unprecedented accuracy once the pathological features of prostate cancer are known.
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影响因子：
6.6
作者：
Porter, Christopher R.;Kodama, Koichi;Karakiewicz, Pierre I.
通讯作者：
Karakiewicz, Pierre I.
接受保守治疗的局限性前列腺癌男性的长期结果。
影响因子：
8.8
作者：
Cuzick, J.;Fisher, G.;Kattan, M. W.;Berney, D.;Oliver, T.;Foster, C. S.;Moller, H.;Reuter, V.;Fearn, P.;Eastham, J.;Scardino, P.
通讯作者：
Scardino, P.
DOI：
10.1093/jnci/djg043
发表时间：
2003-09-17
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
D'Amico, AV;Moul, JW;Chen, MH
通讯作者：
Chen, MH
影响因子：
120.7
作者：
Albertsen, PC;Hanley, JA;Fine, J
通讯作者：
Fine, J
影响因子：
2.1
作者：
Dong, Fel;Reuther, Alwyn M.;Klein, Eric A.
通讯作者：
Klein, Eric A.