A risk-adjusted definition of biochemical recurrence after radical prostatectomy
A risk-adjusted definition of biochemical recurrence after radical prostatectomy
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DOI：
10.1038/pcan.2014.5
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发表时间：
2014-06-01
影响因子：
4.8
通讯作者：
Lin, D. W.
中科院分区：
文献类型：
--
作者：
Morgan, T. M.;Meng, M. V.;Lin, D. W.
背景技术背景：确定基于临床病理学特征的生化复发（BCR）的可变定义是否有助于早期识别可能发生疾病进展的患者。根治性前列腺切除术（RP）后的BCR的定义对患者的咨询和管理具有重要意义，但是，仍然有一个显着的争论，关于适当的definition.METHODS：研究队列包括3619名男性谁接受RP为局限性前列腺癌从1989年至2007年，与数据提取的前列腺癌战略泌尿研究奋进（CaPSURE）注册。根据术后前列腺癌风险评估（CAPRA-S）评分，将患者分为三个风险组。评估了BCR的三个单一阈值PSA临界点（PSA >= 0.05，>= 0.2和>= 0.4 ng ml（-1））以及由风险组定义的可变临界点。达到临界点后，患者进行后续进一步PSA progression.Results：BCR患者的比例不同的临界点和风险组，从7至37%（低风险），22至58%（中等风险）和60至86%（高风险）。预测PSA进一步进展的阳性预测值（PPV）为：PSA ≥ 0.05 ng ml（-1）为49%，PSA ≥ 0.2 ng ml（-1）为62%，PSA ≥ 0.4 ng ml（-1）为65%，风险调整定义为68%。五年无进展生存率为39%的风险调整的定义相比，45-52%的其他定义的BCR.CONCLUSIONS：这些数据表明，一个可变的定义BCR确定的临床病理风险可能会提高识别RP后的早期复发，而不增加过度诊断的BCR。通过使用风险调整的BCR定义，临床医生可以更好地预测未来的PSA进展，并更适当地就挽救治疗向患者提供咨询。
BACKGROUND: To determine whether a variable definition of biochemical recurrence (BCR) based on clincopathologic features facilitates early identification of patients likely to suffer from disease progression. The definition of BCR after radical prostatectomy (RP) bears important implications for patient counseling and management; however, there remains a significant debate regarding the appropriate definition.METHODS: The study cohort consisted of 3619 men who underwent RP for localized prostate cancer from 1989 to 2007, with data abstracted from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry. Patients were stratified into three risk groups according to Cancer of the Prostate Risk Assessment post-Surgical (CAPRA-S) score. Three single threshold PSA cut-points for BCR were evaluated (PSA >= 0.05, >= 0.2 and >= 0.4 ng ml(-1)) as well as a variable cut-point defined by risk group. After reaching the cut-points, patients were followed for further PSA progression.RESULTS: The proportion of patients with BCR differed by cut-point and risk group, ranging from 7 to 37% (low risk), 22 to 58% (intermediate risk) and 60 to 86% (high risk). The positive-predictive value (PPV) for predicting further PSA progression was 49% for the PSA >= 0.05 ng ml(-1), 62% for the PSA >= 0.2 ng ml(-1), 65% for the PSA >= 0.4 ng ml(-1) and 68% for the risk-adjusted definition. Five-year progression-free survival was 39% for the risk-adjusted definition compared with 45-52% for the other definitions of BCR.CONCLUSIONS: These data suggest that a variable definition of BCR determined by clinicopathologic risk may improve the identification of early recurrence after RP without increasing the overdiagnosis of BCR. By using a risk-adjusted BCR definition, clinicians can better predict future PSA progression and more appropriately counsel patients regarding salvage therapies.