Evolution of the clinical presentation of men undergoing radical prostatectomy for high-risk prostate cancer.
Evolution of the clinical presentation of men undergoing radical prostatectomy for high-risk prostate cancer.
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DOI：
10.1111/j.1464-410x.2011.10514.x
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发表时间：
2012-04
影响因子：
4.5
通讯作者：
Schaeffer EM
中科院分区：
文献类型：
--
作者：
Pierorazio PM;Ross AE;Han M;Epstein JI;Partin AW;Schaeffer EM
研究在高危（晚期临床分期[> T2 b]，Gleason评分8-10或前列腺特异性抗原[PSA]水平> 20 ng/mL）前列腺癌（PC）男性中改进纵向筛查的结局和潜在影响。经机构审查委员会批准，根据D 'Amico标准，对机构根治性前列腺切除术数据库（1992-2010）进行了高风险PC男性查询。手术年份分为两个队列：早期PSA时代（EPE，1992-2000）和当代PSA时代（CPE，2001-2010）。使用适当的比较试验评价PC特征和结局。总共有667名男性在EPE中患有高风险PC，764名在CPE中。在EPE中，598名（89.7%）男性表现出一种高风险特征; 173名（29.0%）男性活检时Gleason评分为8-10。在CPE中，717名（93.9%）男性有一个高风险特征（P = 0.004），494名（68.9%）男性的Gleason评分为8-10。10年时，EPE和CPE的无生化生存率（BFS）分别为44.1%和36.4%（P = 0.04）;无肿瘤生存率（MFS）为77.1%和85.1%（P = 0.6）; PC特异性生存率（CSS）为83.3%和96.2%（P = 0.5）。在两个时期，BFS，MFS和CSS对于具有一个以上高风险特征的男性来说更糟。在PSA时代，越来越多的高风险PC男性通过活检Gleason评分8-10进行分类。多种高危特征的累积增加了生化复发、转移发展和PC死亡的风险。BFS、MFS和CSS在PSA时代对这些男性来说是稳定的。更大比例的男性患有高Gleason病和更大比例的小肿瘤之间的平衡，可以解释MFS和CSS随时间的稳定性。
To investigate the outcomes and potential effect of improved longitudinal screening in men presenting with high-risk (advanced clinical stage [> T2b], Gleason score 8–10 or prostate-specific antigen [PSA] level > 20 ng/mL) prostate cancer (PC). The Institutional Review Board approved, Institutional Radical Prostatectomy Database (1992–2010) was queried for men with high-risk PC based on D’Amico criteria. Year of surgery was divided into two cohorts: the Early PSA Era (EPE, 1992–2000) and the Contemporary PSA Era (CPE, 2001–2010). PC features and outcomes were evaluated using appropriate comparative tests. In total, 667 men had high-risk PC in the EPE and 764 in the CPE. In the EPE, 598 (89.7%) men presented with one high-risk feature; 173 (29.0%) men had a Gleason score of 8–10 on biopsy. In the CPE, 717 (93.9%) men presented with one high-risk feature (P = 0.004) and 494 (68.9%) men had a Gleason score of 8–10. At 10 years, biochemical-free survival (BFS) was 44.1% and 36.4% in the EPE and CPE, respectively (P = 0.04); metastases-free survival (MFS) was 77.1% and 85.1% (P = 0.6); and PC-specific survival (CSS) was 83.3% and 96.2% (P = 0.5). BFS, MFS and CSS were worse for men with more than one high-risk feature in both eras. Over the PSA era, an increasing percentage of men with high-risk PC were categorized by a biopsy Gleason score of 8–10. The accumulation of multiple high-risk features increases the risk of biochemical recurrence, the development of metastases and death from PC. BFS, MFS and CSS are stable over the PSA era for these men. The balance between a greater proportion of men having high Gleason disease and a greater proportion with small, less advanced tumours may explain the stability in MFS and CSS over time.