Outcomes of very high-risk prostate cancer after radical prostatectomy: Validation study from 3 centers

被引:42
|
作者
Sundi, Debasish [1 ]
Tosoian, Jeffrey J. [2 ]
Nyame, Yaw A. [3 ]
Alam, Ridwan [2 ]
Achim, Mary [4 ]
Reichard, Chad A. [4 ]
Li, Jianbo [3 ]
Wilkins, Lamont [3 ]
Schwen, Zeyad [2 ]
Han, Misop [2 ]
Davis, John W. [4 ]
Klein, Eric A. [3 ]
Schaeffer, Edward M. [5 ]
Stephenson, Andrew J. [3 ]
Ross, Ashley E. [6 ]
Chapin, Brian F. [4 ]
机构
[1] Ohio State Univ, Dept Urol, Columbus, OH 43210 USA
[2] Johns Hopkins Med Inst, Brady Urol Inst, Baltimore, MD 21205 USA
[3] Cleveland Clin, Glickman Urol Inst, Cleveland, OH 44106 USA
[4] Univ Texas MD Anderson Canc Ctr, Dept Urol, 1515 Holcombe Blvd, Houston, TX 77054 USA
[5] Northwestern Univ, Dept Urol, Feinberg Sch Med, Chicago, IL 60611 USA
[6] Texas Oncol, Dallas, TX USA
关键词
cancer-specific mortality; high-risk localized prostate cancer; metastasis; prostate cancer; risk stratification; ONCOLOGICAL OUTCOMES; SYSTEM;
D O I
10.1002/cncr.31833
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background Among men with localized high-risk prostate cancer (PCa), patients who meet very high-risk (VHR) criteria have been shown to experience worse outcomes after radical prostatectomy (RP) in a previous study. Variations of VHR criteria have been suggested to be prognostic in other single-center cohorts, but multicenter outcomes validating VHR criteria have not been described. This study was designed to validate VHR criteria for identifying which PCa patients are at greatest risk for cancer progression. Methods Patients with high-risk PCa undergoing RP (2005-2015) at 3 tertiary centers were pooled. The outcomes of men with VHR PCa were compared with the outcomes of those who did not meet VHR criteria. The high-risk criteria were a clinical stage of T3 to T4, a prostate-specific antigen level > 20 ng/mL, or a biopsy Gleason grade sum of 8 to 10. The VHR criteria were multiple high-risk features, >4 biopsy cores with a Gleason grade sum of 8 to 10, or primary Gleason grade pattern 5. Biochemical recurrence, metastasis (METS), and cancer-specific mortality (CSM) were assessed with competing risks regressions. Overall mortality was assessed with Cox survival models. Results Among 1981 patients with high-risk PCa, men with VHR PCa (n = 602) had adverse pathologic outcomes: 37% versus 25% for positive margins and 37% versus 15% for positive lymph nodes (P < .001 for both comparisons). Patients with VHR PCa also had higher adjusted hazard ratios for METS (2.78; 95% confidence interval [CI], 2.08-3.72), CSM (6.77; 95% CI, 2.91-15.7), and overall mortality (2.44; 95% CI, 1.56-3.80; P < .001 for all comparisons). Conclusions In a validation study of patients who underwent treatment for high-risk PCa, VHR criteria were strongly associated with adverse pathologic and oncologic outcomes.
引用
收藏
页码:391 / 397
页数:7
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