Prediction of progression following radical prostatectomy - A multivariate analysis of 721 men with long-term follow-up
Prediction of progression following radical prostatectomy - A multivariate analysis of 721 men with long-term follow-up
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DOI：
10.1097/00000478-199603000-00004
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发表时间：
1996-03-01
影响因子：
5.6
通讯作者：
Walsh, PC
中科院分区：
文献类型：
--
作者：
Epstein, JI;Partin, AW;Walsh, PC
我们研究了 721 名患有临床局限性疾病并接受根治性前列腺切除术的男性。在发生进展之前，没有患者接受术前或术后放疗或激素治疗。对于那些没有进展的男性，平均随访时间为 6.5 年，中位数为 6 年（范围 1 至 12 年）。由于淋巴结转移或精囊侵犯的患者进展风险很高，因此对于有这些发现的男性不需要增强预后。因此，我们将分析重点放在 617 名没有淋巴结转移或精囊侵犯的男性上。在多变量分析中，格里森评分（P < 0.0001）、手术切缘（P = 0.004）和囊膜穿透（P = 0.007）都是进展的独立预测因子。格里森评分为 2 至 4 分的肿瘤几乎都能治愈，10 年无进展风险为 96%。另一方面，格里森评分为 8 至 9 分的男性 10 年精算无进展风险为 35%。格里森评分为 2 至 4 或 8 至 9 级肿瘤的男性无法根据包膜穿透或边缘状态的存在或程度分为不同的进展风险。对于格里森评分为 5 至 7 级肿瘤的男性（88.2% 的病例），通过了解肿瘤的包膜穿透和边缘状态，可以增强预测其进展风险的能力。格里森评分为 5 至 6 和 7 分的肿瘤均分为三组，具有不同的进展风险。使用本研究中的精算曲线，医生将能够根据根治性前列腺切除术格里森评分、包膜穿透程度和手术切缘状态的组合，更准确地确定患者在根治性前列腺切除术后的进展风险。
We studied 721 men with clinically confined disease who underwent radical prostatectomy. No patient received preoperative or postoperative radiotherapy or hormone therapy until progression occurred. For those men without progression, the mean follow-up was 6.5 years with a median of 6 years (range 1 to 12 years). Because patients with lymph node metastases or seminal vesicle invasion had such a high risk of progression, enhanced prognostication was not needed in men with these findings. Thus we focused this analysis on the 617 men without lymph node metastases or seminal vesicle invasion. In the multivariate analysis, Gleason score (P < 0.0001), surgical margins (P = 0.004), and capsular penetration (P = 0.007) were all independent predictors of progression. Tumors with a Gleason score of 2 through 4 were almost invariably cured, with a 10-year progression-free risk of 96%. At the opposite end of the spectrum, the 10-year actuarial progression-free risk for men with a Gleason score of 8 through 9 was 35%. Men with Gleason score 2 through 4 or 8 through 9 tumors could not be stratified into different risks of progression based on the presence or extent of capsular penetration or margin status. For the men with Gleason score 5 through 7 tumors (88.2% of cases), predicting their risk of progression was enhanced by knowledge of their tumor's capsular penetration and margin status. Tumors with a Gleason score of 5 through 6 and 7 were each stratified into three groups with different risks of progression. Using the actuarial curves within this study, physicians will be able to more accurately determine a patient's risk of progression following radical prostatectomy based on a combination of the radical prostatectomy Gleason score, extent of capsular penetration, and status of surgical margins of resection.