Predicting recurrence after radical prostatectomy for patients with high risk prostate cancer
Predicting recurrence after radical prostatectomy for patients with high risk prostate cancer
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DOI：
10.1016/s0022-5347(05)64058-x
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发表时间：
2003-01-01
影响因子：
6.6
通讯作者：
Carroll, PR
中科院分区：
文献类型：
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作者：
Grossfeld, GD;Latini, DM;Carroll, PR
目的：既往研究表明，临床分期为T2 c-T3的前列腺癌患者，诊断时血清前列腺特异性抗原（PSA）大于20 ng。ml.或活检Gleason评分为8至10的患者在根治性乳腺癌切除术后具有疾病复发的高风险。我们确定了最重要的预处理预测疾病复发的高危population.Materials和方法：我们确定了547例高危前列腺癌患者进行根治性前列腺切除术在加州大学，旧金山弗朗西斯科或作为前列腺癌战略泌尿研究奋进数据库，纵向疾病登记的前列腺癌患者的一部分。高危疾病定义为1992年美国癌症联合委员会临床分期为T2 c-T3疾病的411例患者，诊断时血清PSA大于20 ng。ml. Gleason评分8 ~ 10分者114例。疾病复发定义为PSA 0.2 ng。/ ml.根治性膀胱癌切除术后或术后6个月以上的第二次癌症治疗后连续2次或更高。进行考克斯比例风险分析以确定疾病复发的显著独立预测因子。使用Kaplan-Meier方法确定临床相关患者组疾病复发的可能性，并使用对数秩检验进行比较。结果：手术后的中位随访时间为3.1年。177例患者（32%）疾病复发。多变量分析表明，诊断时的血清PSA、活检Gleason评分、种族和前列腺活检阳性率是疾病复发的独立预测因素，而患者年龄和临床肿瘤分期则不是。肿瘤Gleason评分为8 - 10且血清PSA <10 ng的患者。/ ml.或更少的患者在手术后5年内保持无病的可能性显著高于PSA大于10 ng的患者。ml. (47%对19%，p
Purpose: Previous studies have shown that patients with clinical stage T2c-T3 prostate cancer, serum prostate specific antigen (PSA) at diagnosis greater than 20 ng./ml. or a biopsy Gleason score of 8 to 10 are at high risk for disease recurrence after radical prostatectomy. We determined the most important pretreatment predictors of disease recurrence in this high risk population.Materials and Methods: We identified 547 patients with high risk prostate cancer who underwent radical prostatectomy at University of California, San Francisco or as part of the Cancer of the Prostate Strategic Urological Research Endeavor data base, a longitudinal disease registry of patients with prostate cancer. High risk disease was defined as 1992 American Joint Committee on Cancer clinical stage T2c-T3 disease in 411 patients, serum PSA at diagnosis greater than 20 ng./ml. in 124 and/or biopsy Gleason score 8 to 10 in 114. Disease recurrence was defined as PSA 0.2 ng./ml. or greater on 2 consecutive occasions after radical prostatectomy or second cancer treatment more than 6 months after surgery. The Cox proportional hazards analysis was performed to determine significant independent predictors of disease recurrence. The likelihood of disease recurrence for clinically relevant patient groups was determined using the Kaplan-Meier method and compared using the log rank test.Results: Median followup after surgery was 3.1 years. Disease recurred in 177 patients (32%). Multivariate analysis demonstrated that serum PSA at diagnosis, biopsy Gleason score, ethnicity, and the percent of positive prostate biopsies were significant independent predictors of disease recurrence, while patient age and clinical tumor stage were not. Patients with a Gleason score 8 to 10 tumor and a serum PSA of 10 ng./ml. or less had a significantly higher likelihood of remaining disease-free 5 years after surgery than those with PSA greater than 10 ng./ml. (47% versus 19%, p