Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer
Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer
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DOI：
10.1016/s0022-5347(05)63946-8
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发表时间：
2003-02-01
影响因子：
6.6
通讯作者：
Walsh, PC
中科院分区：
文献类型：
--
作者：
Han, M;Partin, AW;Walsh, PC
目的：我们回顾性分析了一系列临床局限性前列腺癌患者的临床随访，这些患者接受了根治性耻骨后前列腺切除术，以确定生化（前列腺特异性抗原[PSA]）复发的临床和/或病理指标。然后，我们使用这些指标来开发多变量模型，以确定复发概率根治性耻骨后spectroscopy.Materials和方法：从1982年至1999年，2,091连续男性进行根治性耻骨后spectroscopy. pelvic淋巴结切除术和盆腔淋巴结切除术的临床局限性腺癌的前列腺（临床阶段T1 C或T2疾病与Gleason评分5分或更高）。进行精算分析，比较根治性耻骨后前列腺切除术（PSA 0.2 ng./ ml.或更大）。使用Kaplan-Meier方法。使用对数秩统计或考克斯比例风险回归模型比较至复发时间的事件时间分布。第一个模型仅使用术前变量开发，第二个模型使用所有可用变量。观察到的和预测的无复发生存曲线不同的模型进行了比较，选择一个模型，用于计算预测的无复发概率和置信区间。结果：随访中位数为5.9年（范围1至17）360人（17%）生化复发。总体精算5年、10年和15年生化无复发生存率分别为84%、72%和61%。术后生化复发的相对风险随着时间的推移而降低，即使在调整了其他围手术期参数后。术前模型确定的变量为活检Gleason评分、临床TNM分期和PSA。术后模型确定的变量是前列腺切除术Gleason评分、PSA和病理器官限制状态。诺模图生成和校正的生化复发随着时间的推移降低相对风险。结论：使用3术前或术后参数，这些诺模图可以很容易地用于确定3，5，7和10年的生化无复发生存概率的男性谁接受根治性耻骨后前列腺切除术的临床局限性前列腺癌在现代。
Purpose: We retrospectively reviewed the clinical followup for a large series of men with clinically localized prostate cancer who underwent radical retropubic prostatectomy to identify clinical and/or pathological indicators of biochemical (prostate specific antigen [PSA]) recurrence. We then used those indicators to develop multivariate models for determination of recurrence probability following radical retropubic prostatectomy.Materials and Methods: From 1982 to 1999, 2,091 consecutive men underwent radical retropubic prostatectomy and pelvic lymphadenectomy for clinically localized adenocarcinoma of the prostate (clinical stage T1c or T2 disease with Gleason score 5 or greater). Actuarial analysis was performed comparing freedom from biochemical recurrence after radical retropubic prostatectomy (PSA 0.2 ng./ml. or greater.) using the Kaplan-Meier method. Event time distributions for the time to recurrence were compared using the log rank statistic or the Cox proportional hazards regression model. The first model was developed using preoperative variables only and the second model using all available variables. Observed and predicted recurrence-free survival curves for different models were compared to select a model for calculation of predicted recurrence-free probabilities and confidence intervals.Results: With a median followup of 5.9 years (range 1 to 17) 360 men (17%) had biochemical recurrence. Overall actuarial 5, 10 and 15-year biochemical recurrence-free survival rates were 84%, 72% and 61%, respectively. The relative risk of biochemical recurrence following surgery decreased with time, even after adjusted for other perioperative parameters. Variables identified for the preoperative model were biopsy Gleason score, clinical TNM stage and PSA. Variables identified for the postoperative model were prostatectomy Gleason score, PSA and pathological organ confinement status. Nomograms were generated and corrected for the decreasing relative risk of biochemical recurrence over time.Conclusions: Using 3 preoperative or postoperative parameters, these nomograms can easily be used to determine the 3, 5, 7 and 10-year biochemical recurrence-free survival probabilities among men who undergo radical retropubic prostatectomy for clinically localized prostate cancer in the modern era.