Intermediate‐Term Outcome with Radical Prostatectomy for Localized Prostate Cancer: The Cleveland Clinic Experience

P. Clark, H. Levin, P. Kupelian, C. Reddy, C. Zippe, E. Klein
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引用次数: 12

Abstract

Purpose: We examined the results after radical prostatectomy (RP) for clinically localized prostate cancer to determine the 5- and 8-year disease-specific and biochemical relapse-free survival (bRFS), and the clinical and pathologic variables that predict biochemical failure. Materials and Methods: Nine hundred six patients underwent RP for clinically localized prostate cancer between 1990 and 1999. No patient received neoadjuvant or adjuvant therapy. The mean age was 61.9 years (range 40–77 years). The mean preoperative prostate specific antigen (PSA) level was 8.7 ng/ml (range 0.3–54.0). Seventy-six percent of patients had a biopsy Gleason score ≤6, and 49% had disease at clinical Stage T1c. Eighteen percent of patients reported a family history of prostate cancer. Actuarial bRFS rates were calculated using Kaplan-Meier analysis. Results: Pathologic analysis showed that 43% of patients had extracapsular extension, 44% had pathologic Gleason scores ≤6, 23% had positive margins, 8.9% had seminal vesicle invasion, and 1.9% had lymph node metastases. At a mean follow-up of 44 months (range 1–114), the 5- and 8-year cancer-specific survival rates were 97% and 95%, respectively. The actuarial 5- and 8-year bRFS rates were 81% and 76%, respectively. Patients with organ-confined disease had a 100% cancer-specific survival rate and a 92% bRFS rate at both 5 and 8 years. On multivariate analysis, a positive family history (p = 0.019), clinical stage (p = 0.014), preoperative PSA level (p < 0.001), pathologic Gleason score (p < 0.001), extracapsular extension (p = 0.03), positive margins (p < 0.0001), and seminal vesicle invasion (p = 0.0003) were all independent predictors of bRFS. Conclusion: Radical prostatectomy for patients with localized prostate cancer has a high rate of cure for appropriately selected patients.
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根治性前列腺切除术治疗局限性前列腺癌的中期疗效:克利夫兰诊所的经验
目的:研究临床局限性前列腺癌根治性前列腺切除术(RP)后的结果,以确定5年和8年疾病特异性和生化无复发生存(bRFS),以及预测生化失败的临床和病理变量。材料与方法:1990年至1999年间,960例临床局限性前列腺癌患者接受了RP治疗。无患者接受新辅助或辅助治疗。平均年龄61.9岁(40 ~ 77岁)。术前前列腺特异性抗原(PSA)平均水平为8.7 ng/ml(范围0.3 ~ 54.0)。76%的患者活检Gleason评分≤6,49%的患者临床分期为T1c。18%的患者报告有前列腺癌家族史。精算bRFS率采用Kaplan-Meier分析计算。结果:病理分析显示,43%的患者有囊外延伸,44%的患者病理Gleason评分≤6分,23%的患者有切缘阳性,8.9%的患者有精囊浸润,1.9%的患者有淋巴结转移。平均随访44个月(范围1-114),5年和8年癌症特异性生存率分别为97%和95%。精算5年和8年bRFS率分别为81%和76%。器官局限性疾病患者在5年和8年的癌症特异性生存率为100%,bRFS为92%。在多因素分析中,阳性家族史(p = 0.019)、临床分期(p = 0.014)、术前PSA水平(p < 0.001)、病理Gleason评分(p < 0.001)、囊外延伸(p = 0.03)、阳性边缘(p < 0.0001)和精囊浸润(p = 0.0003)都是bRFS的独立预测因素。结论:选择合适的患者行根治性前列腺切除术,治愈率高。
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