Disease-specific outcomes of Radical Prostatectomies in Northern Norway; a case for the impact of perineural infiltration and postoperative PSA-doubling time
Disease-specific outcomes of Radical Prostatectomies in Northern Norway; a case for the impact of perineural infiltration and postoperative PSA-doubling time
复制标题
DOI：
10.1186/1471-2490-14-49
复制
发表时间：
2014-06-14
期刊：
影响因子：
2
通讯作者：
Bremnes, Roy M.
中科院分区：
文献类型：
--
作者：
Andersen, Sigve;Richardsen, Elin;Bremnes, Roy M.
背景：前列腺癌是西方世界最常见的男性恶性肿瘤，也是主要的死亡原因之一。临床病理变量对疾病相关结果的影响主要来自少数大型美国系列报道，其中大多数未报道神经周围浸润。因此，我们希望研究挪威两个卫生地区接受根治性前列腺切除术患者的相关癌症结局，重点研究神经周围浸润（PNI）和前列腺特异性抗原加倍时间（PSA-DT）的影响。方法：采用Kaplan-Meier法对1995 - 2005年3家医院535例前列腺切除术患者的生化失败（BFFS）、临床失败（CFFS）和前列腺癌无死亡生存（PCDFS）进行回顾性分析。我们使用cox比例风险回归研究影响事件风险的临床病理因素。结果：中位随访89个月后，170例（32%）患者出现生化失败（BF）， 36例（7%）出现临床失败，15例（3%）患者死于前列腺癌。pt分期（p = 0.001）、术前PSA （p = 0.047）、Gleason评分（p = 0.032）、非根尖阳性手术切缘（PSM） （p = 0.003）和根尖阳性手术切缘（PSM） （p = 0.031）均与闺中好友独立相关。Gleason评分（p = 0.019）、PNI评分（p = 0.012）和非根尖PSM评分（p = 0.002）均与CFFS独立相关，只有PNI评分（p = 0.047）和Gleason评分亚组与PCDFS独立相关。BF治疗后，PSA-DT较短患者的独立无事件生存率显著低于PSA-DT患者（PSA-DT = 3-9个月，CFFS HR = 6.44, p < 0.001, PCDFS HR = 13.7, p = 0.020; PSA-DT < 3个月，CFFS HR = 11.2, p < 0.001, PCDFS HR = 27.5, p = 0.006）。结论：前列腺切除术后，CFFS和PCDFS是可变的，但两者都与Gleason评分和PNI有很强的相关性。在BF患者中，PSA-DT与CF和PCD的相关性最强。我们的研究增加了PSA-DT的重要性，并重新将PNI作为临床相关终点的有力预测指标。
Background: Prostate cancer is the most common male malignancy and a mayor cause of mortality in the western world. The impact of clinicopathological variables on disease related outcomes have mainly been reported from a few large US series, most of them not reporting on perineural infiltration. We therefore wanted to investigate relevant cancer outcomes in patients undergoing radical prostatectomy in two Norwegian health regions with an emphasis on the impact of perineural infiltration (PNI) and prostate specific antigen- doubling time (PSA-DT).Methods: We conducted a retrospective analysis of 535 prostatectomy patients at three hospitals between 1995 and 2005 estimating biochemical failure- (BFFS), clinical failure- (CFFS) and prostate cancer death-free survival (PCDFS) with the Kaplan-Meier method. We investigated clinicopathological factors influencing risk of events using cox proportional hazard regression.Results: After a median follow-up of 89 months, 170 patients (32%) experienced biochemical failure (BF), 36 (7%) experienced clinical failure and 15 (3%) had died of prostate cancer. pT-Stage (p = 0.001), preoperative PSA (p = 0.047), Gleason Score (p = 0.032), non-apical positive surgical margins (PSM) (p = 0.003) and apical PSM (p = 0.031) were all independently associated to BFFS. Gleason score (p = 0.019), PNI (p = 0.012) and non-apical PSM (p = 0.002) were all independently associated to CFFS while only PNI (P = 0.047) and subgroups of Gleason score were independently associated to PCDFS. After BF, patients with a shorter PSA-DT had independent and significant worse event-free survivals than patients with PSA-DT > 15 months (PSA-DT = 3-9 months, CFFS HR = 6.44, p < 0.001, PCDFS HR = 13.7, p = 0.020; PSA-DT < 3 months, CFFS HR = 11.2, p < 0.001, PCDFS HR = 27.5, p = 0.006).Conclusions: After prostatectomy, CFFS and PCDFS are variable, but both are strongly associated to Gleason score and PNI. In patients with BF, PSA-DT was most strongly associated to CF and PCD. Our study adds weight to the importance of PSA-DT and re-launches PNI as a strong prognosticator for clinically relevant endpoints.