Disease recurrence and progression in untreated pathological stage T3 prostate cancer: Selecting patient for adjuvant therapy.
Disease recurrence and progression in untreated pathological stage T3 prostate cancer: Selecting patient for adjuvant therapy.
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DOI：
10.1016/s0022-5347(01)64240-x
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发表时间：
1997-10-01
影响因子：
6.6
通讯作者：
Lieberman, SF
中科院分区：
文献类型：
--
作者：
Lowe, BA;Lieberman, SF
目的：病理性 T3 前列腺癌的最佳治疗尚不明确。我们对未经治疗的 pT3 患者进行了一项前瞻性研究，以提高对该疾病自然史的了解，并确定有助于患者选择辅助治疗的临床参数。 材料和方法：在 583 例接受全前列腺切除术治疗的临床 T1 至 2 期疾病的连续患者中，206 例患有 pT3 疾病。排除要求立即辅助治疗或新辅助治疗的患者，共有 156 名受试者符合研究资格，其中 34 名患有 pT3a、80 名 pT3b、22 名 pT3c 和 20 名 pT3N+ 疾病。对患者进行随访，观察前列腺特异性抗原 (PSA) 复发是否大于 0.2 ng./ml。结果：中位 45 个月后，pT3a 的 29.4%（10/34）、pT3b 的 30%（24/80）、pT3c 的 27.3%（6/22）和 pT3N+ 的 80%（16/20）出现 PSA 复发。局部或远处进展见于 2.9% 的 pT3a (1)、6.2% 的 pT3b (5)、9.1% 的 pT3c (2) 和 55% 的 pT3N+（II 例）。复发和进展与肿瘤涉及的手术切缘数量、病理格里森评分和前列腺切除术前基线 PSA 水平相关。 PSA 复发发生在 1 个手术切缘受累的患者中，为 20.8% (10/48)，有 2 个切缘受累的患者为 40.9% (9/22)，有 3 个或更多切缘受累的患者为 50% (5/10)。格里森评分低于 7 时，PSA 复发率为 20.3% (14/69)；评分为 7 时，PSA 复发率为 33.9% (19/56)；评分大于 7 时，PSA 复发率为 74.2% (23/31)。前列腺切除术前 PSA 水平低于 10 ng./ml。与 17.3% (14/81) 和 45.4% (25/55) 的 PSA 复发相关，且水平高于 10 ng./ml。根据这些参数的结果选择高风险或低风险的患者可以准确预测 PSA 复发；低风险患者为 8.5% (4/47)，高风险患者为 44.8% (30/67)。低风险患者中没有观察到肿瘤进展，而高风险患者中则有 9% (6) 观察到肿瘤进展。 2 个风险组之间的差异非常显着 (p
Purpose: Optimal management of pathologic T3 prostate cancer is poorly defined. We conducted a prospective study of untreated pT3 patients to improve understanding of the natural history of this disease and to identify clinical parameters useful in patient selection for adjuvant therapy.Materials and Methods: Of 583 consecutive patients with clinical stage T1 to 2 disease managed by total prostatectomy, 206 had pT3 disease. Excluding patients requesting immediate adjuvant treatment or neoadjuvant therapy, 156 subjects were eligible for the study, including 34 with pT3a, 80 pT3b, 22 pT3c, and 20 pT3N+ disease. Patients were followed for prostate-specific antigen (PSA) recurrence of greater than 0.2 ng./ml. and biopsy proved local or distant tumor progression demonstrated by imaging studies.Results: After a median of 45 months, PSA recurrence was seen in 29.4% of pT3a (10/34), 30% of pT3b (24/80), 27.3% of pT3c (6/22), and 80% of pT3N+ (16/20 eases). Local or distant progression was seen in 2.9% of pT3a (1), 6.2% of pT3b (5), 9.1% of pT3c (2), and 55% of pT3N+ (II cases). Recurrence and progression correlated with the number of surgical margins involved by tumor, pathological Gleason score and baseline pre-prostatectomy PSA levels. PSA recurrence was seen in 20.8% (10/48) patients with 1 surgical margin involved, 40.9% (9/22) with 2 margins involved and 50% (5/10) with 3 or more margins involved. PSA recurrence was 20.3% (14/69) with Gleason scores of less than 7, 33.9% (19/56) with a score of 7 and 74.2% (23/31) with scores of greater than 7. Pre-prostatectomy PSA levels less than 10 ng./ml. were associated with a PSA recurrence of 17.3% (14/81) and 45.4% (25/55), with levels greater than 10 ng./ml. Selecting patients for high or low risk based upon the results of these parameters allowed accurate prediction of PSA recurrence; 8.5% (4/47) for low risk patients and 44.8% (30/67) for high risk. Tumor progression was seen in no low risk patient and in 9% (6) with high risk. The difference between the 2 risk groups was highly significant (p