生殖器系と性的障害: 現在の研究
オープンアクセス

概要

Margin-Positive Radical Prostatectomy: All High Risk? PSA Relapse Risk Subset Identification via Recursive Partitioning Analysis

Mitchell DL, Russo JK, Mott SL, Snow AN, Tracy CR, Buatti JM and Watkins JM

Objectives: To stratify risk of PSA relapse in a large population of men with positive surgical margin(s) at radical prostatectomy for prostate cancer.

Methods: A multi-institutional retrospective analysis of patient-and tumor-specific factor association with PSA (biochemical) relapse-free survival is reported. Eligible patients underwent radical prostatectomy for clinically localized prostate cancer, without pathologic involvement of seminal vesicles or lymph nodes, and >1 site of cancer involvement at the surgical margin. Patients were excluded for pre-prostatectomy PSA >30 or adjuvant (nonsalvage) radiotherapy or hormone therapy. PSA failure was defined as PSA >0.10 ng/mL and rising, or at salvage intervention. Kaplan-Meier method was employed for survival estimates; recursive partitioning analysis by conditional inference analysis was applied to identify variables associated with PSA relapse-free survival.

Results: Between 2002 and 2010, 215 patients with margin-positive prostatectomy were eligible for analysis. The median age at diagnosis was 61 years (range, 43 years to 76 years), and median pre-prostatectomy PSA was 5.8 ng/mL (1.6-26.0). At a median follow-up of 78 months (14 months to 155 months; with 42% followed >8 years), 85 patients had experienced PSA relapse. At multivariable analysis, primary Gleason grade, pT-stage, and initial postprostatectomy PSA were significant. Recursive partitioning analysis yielded 3 discrete risk groups, including a lowerrisk group with 78% PSA relapse-free survival at 5 years (initial post-prostatectomy PSA <0.1, Gleason score <7).

Conclusion: Among patients with margin-positive prostatectomy, Gleason score and initial post-prostatectomy PSA permitted risk substratification for PSA relapse-free survival.