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Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy
The aim of this study is to identify optimal patients for adjuvant radiation therapy (ART) in pT3 prostate cancer. The role of ART for patients with adverse pathologic features after radical prostatectomy (RP) has been demonstrated, but over- or under-treatment remains a significant concern. Two-hun...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2017
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676431/ https://www.ncbi.nlm.nih.gov/pubmed/28230003 http://dx.doi.org/10.4103/1008-682X.193569 |
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author | Hong, Jeong Hee Kwon, Young Suk Kim, Isaac Yi |
author_facet | Hong, Jeong Hee Kwon, Young Suk Kim, Isaac Yi |
author_sort | Hong, Jeong Hee |
collection | PubMed |
description | The aim of this study is to identify optimal patients for adjuvant radiation therapy (ART) in pT3 prostate cancer. The role of ART for patients with adverse pathologic features after radical prostatectomy (RP) has been demonstrated, but over- or under-treatment remains a significant concern. Two-hundred and five patients with pT3N0M0 who underwent robot-assisted RP without ART were analyzed. Multivariate Cox proportional regression analyses were used to identify predictors of biochemical recurrence (BCR) and clinical progression (CP). The estimated 5-year BCR-free survival (BCRFS) and CP-free survival (CPFS) were 52.8% and 85.6%, respectively. Preoperative prostate-specifc antigen (PSA) ≥10 ng ml(−1) (hazard ratio [HR]: 3.288–6.027; P = 0.003), pathologic Gleason score (pGS) ≥8 (HR: 4.146; P = 0.014), and lymphovascular invasion (LVI) (HR: 2.167; P = 0.026) were associated with BCR. Based on these factors, a risk stratification tool was developed. Patients with no risk factors (PSA <10 ng ml(−1), pGS 6, and absent LVI) showed excellent BCRFS and CPFS at 5 years (91.9% and 100.0%, respectively), but those with two or more risk factors (PSA ≥10 ng ml(−1), pGS ≥8, or present LVI) had poor BCRFS and CPFS (12.1% and 54.6%, respectively). In addition, the multivariate analysis revealed that pathologic stage pT3b (HR: 5.393; P = 0.025) was the only predictor of CP. Our study demonstrated the heterogeneity of oncologic outcomes in patients with pT3 prostate cancer. The proposed risk stratification can be used to identify patients who are at risk for disease progression and may aid in identifying the best patients for ART. |
format | Online Article Text |
id | pubmed-5676431 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-56764312017-11-17 Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy Hong, Jeong Hee Kwon, Young Suk Kim, Isaac Yi Asian J Androl Original Article The aim of this study is to identify optimal patients for adjuvant radiation therapy (ART) in pT3 prostate cancer. The role of ART for patients with adverse pathologic features after radical prostatectomy (RP) has been demonstrated, but over- or under-treatment remains a significant concern. Two-hundred and five patients with pT3N0M0 who underwent robot-assisted RP without ART were analyzed. Multivariate Cox proportional regression analyses were used to identify predictors of biochemical recurrence (BCR) and clinical progression (CP). The estimated 5-year BCR-free survival (BCRFS) and CP-free survival (CPFS) were 52.8% and 85.6%, respectively. Preoperative prostate-specifc antigen (PSA) ≥10 ng ml(−1) (hazard ratio [HR]: 3.288–6.027; P = 0.003), pathologic Gleason score (pGS) ≥8 (HR: 4.146; P = 0.014), and lymphovascular invasion (LVI) (HR: 2.167; P = 0.026) were associated with BCR. Based on these factors, a risk stratification tool was developed. Patients with no risk factors (PSA <10 ng ml(−1), pGS 6, and absent LVI) showed excellent BCRFS and CPFS at 5 years (91.9% and 100.0%, respectively), but those with two or more risk factors (PSA ≥10 ng ml(−1), pGS ≥8, or present LVI) had poor BCRFS and CPFS (12.1% and 54.6%, respectively). In addition, the multivariate analysis revealed that pathologic stage pT3b (HR: 5.393; P = 0.025) was the only predictor of CP. Our study demonstrated the heterogeneity of oncologic outcomes in patients with pT3 prostate cancer. The proposed risk stratification can be used to identify patients who are at risk for disease progression and may aid in identifying the best patients for ART. Medknow Publications & Media Pvt Ltd 2017 2017-02-21 /pmc/articles/PMC5676431/ /pubmed/28230003 http://dx.doi.org/10.4103/1008-682X.193569 Text en Copyright: © The Author(s)(2017) http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Hong, Jeong Hee Kwon, Young Suk Kim, Isaac Yi Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy |
title | Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy |
title_full | Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy |
title_fullStr | Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy |
title_full_unstemmed | Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy |
title_short | Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy |
title_sort | risk stratification for disease progression in pt3 prostate cancer after robot-assisted radical prostatectomy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676431/ https://www.ncbi.nlm.nih.gov/pubmed/28230003 http://dx.doi.org/10.4103/1008-682X.193569 |
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