- 作者：Phillip M. Pierorazio ; Thomas J. Guzzo ; Misop Han ; Trinity J. Bivalacqua ; Jonathan I. Epstein ; Edward M. Schaeffer ; Mark Schoenberg ; Patrick C. Walsh ; Alan W. Partin
- 刊名：Urology
- 出版年：2010
- 出版时间：September 2010
- 年：2010
- 卷：76
- 期：3
- 页码：715-721
- 全文大小：244 K
Objectives
To evaluate the long-term outcomes of patients with high Gleason sum 8-10 at radical prostatectomy (RP) and to identify the predictors of prostate cancer-specific survival (CSS) in this cohort.Methods
The institutional RP database was queried. A total of 9381 patients with complete follow-up underwent RP from 1982 to 2008. Of these 9381 patients, 1061 had pathologic Gleason sum 8-10 cancer. The patient and prostate cancer characteristics were evaluated. Survival analyses were performed using the Kaplan-Meier method. Univariate and multivariate proportional hazard regression models were created to evaluate the pertinent predictors of CSS (death from, or attributed to, prostate cancer).
Results
The median preoperative prostate-specific antigen level was 7.6 ng/mL; 435 men had clinical Stage T1 tumor, 568 had Stage T2, and 36 had Stage T3. The biopsy Gleason sum was <7, 7, and >7 in 244 (22.3 % ), 406 (37.2 % ), and 425 (38.9 % ) patients, respectively. The median follow-up was 5 years (range 1-23). The actuarial 15-year recurrence-free survival, CSS, and overall survival rate was 20.7 % , 57.4 % , and 45.4 % , respectively. On multivariate analysis, the predictors of poor CSS were pathologic Gleason sum 9-10 and seminal vesicle and lymph node involvement. Patients with pathologic Gleason sum 8 and organ-confined disease had a CSS rate of 89.9 % at 15 years.
Conclusions
The results of our study have shown that 80 % of the men with Gleason sum 8-10 who undergo RP will have experienced biochemical recurrence by 15 years. However, the CSS rate approached 90 % for men with pathologic organ-confined disease. Higher pathologic Gleason sum 9-10 and seminal vesicle and lymph node involvement were independent predictors of worse CSS.