ABSTRACT
Evaluar pacientes con puntaje de Gleason de 7 sometidos a Prostatectomía Radical (PR) y determinar factores predictores de sobrevida libre de recidiva bioquímica (SL-RB). MATERIALES Y MÉTODOS: Se analizó una cohorte histórica de 1059 pacientes con Cáncer de Próstata sometidos a PR entre 1999 y 2012, de los cuales 490 cumplieron criterios de inclusión. Se definió como recidiva bioquímica (RB) un APE >0,2 ng/ml. Se consideró significativo un valor p < 0.05. RESULTADOS: La edad promedio y mediana de APE preoperatorio fue de 63 años y 6.6 ng/ml, respectivamente. Se observó RB en el 19,8 por ciento de esta serie con una mediana de seguimiento de 49 meses. El análisis multivariado demostró que los márgenes quirúrgicos (MQ) positivos (HR 1,76, p=0,01), T patológico (pT2 versus pT3, HR 2,0, p=0,007) y el porcentaje de cáncer en la pieza operatoria (HR 1,01, p=0,002) son predictores de SL-RB. El Gleason primario (3+4 versus 4+3) no fue un predictor de SL-RB (p=0,29). CONCLUSIONES: El Gleason primario no es un factor relevante para predecir RB en pacientes con GS 7 patológico. Sin embargo, los MQ positivos, el porcentaje de cáncer en la pieza operatoria, APE preoperatorio y la presencia pT3 son factores predictores de RB en pacientes con GS 7 y por lo tanto a considerar para decidir terapia adyuvante.
To evaluate patients with Gleason score 7 who underwent radical prostatectomy (RP) and to determine predictors of biochemical recurrence-free survival (SL-RB). MATERIALS AND METHODS: A historical cohort of 1059 patients with prostate cancer who underwent RP between 1999 and 2012, of which 490 met the inclusion criteria were analyzed. Biochemical recurrence (BR) was defined as a PSA > 0.2 ng / ml. A value of p < 0.05 was considered significant. RESULTS: Mean age was 63y-o and median preoperative PSA and 6.6 ng / ml. RB was observed in 19.8 percent of this series, with a median follow up of 49 months. Multivariate analysis showed that positive surgical margins (MQ) (HR 1.76, p = 0.01), pathological T (pT2 versus pT3, HR 2.0, p = 0.007) and the percentage of cancer in the surgical specimen (HR 1.01, p = 0.002) were predictors of SL-RB. Primary Gleason (3 +4 versus 4 +3) was not a predictor of SL-RB (p = 0.29). CONCLUSIONS: Primary Gleason is not relevant for predicting biochemical recurrence (RB) in patients with GS 7 pathological factor. However, positive margins, percentage of cancer in the surgical specimen, preoperative PSA and the presence pT3 are predictors of RB in patients with GS 7 and therefore they must be considered to decide for adjuvant therapy.
Subject(s)
Humans , Male , Middle Aged , Prostatic Neoplasms/surgery , Prostatectomy/methods , Multivariate Analysis , Neoplasm Staging , Follow-Up Studies , Forecasting , Recurrence , Neoplasm Recurrence, Local , Disease-Free SurvivalABSTRACT
Objective: To compare the clinical characteristics of patients with Gleason score 3+4 and Gleason score 4+3 after radical prostatectomy for prostate cancer. Methods: The clinical records of patients who underwent radical retropubic prostatectomy in our hospital from 2001 to 2006 were retrospectively analyzed. Thirty-seven patients with a Gleason score of 7 after operation were divided into 2 groups, Gleason score 3+4 group and Gleason score 4+3 group, according to major grading. The patients were followed up for biochemical recurrence and distant metastases. Radioimmunoassay was used to detect the serum prostate-specific antigen (PSA) level. Kaplan-Meier method was used to compare the progression-free survival curves and Cox regression model was used to analyze the independent factors influencing the disease progression. Results: The rates of extraprostatic extension at radical prostatectomy were not significantly different between 3+4 and 4+3 groups (21.1% vs 33.3%, P=0.462). The non-progression survival time of 3+4 group was markedly longer than that of 4+3 group (P= 0.030). Cox regression model showed that Gleason primary grade was an independent factor o[prognosis (P=0.033). 4+3 group had a higher risk for biochemical recurrence. Conclusion: Prostate cancers of Gleason score 7 with different grades have different biologic behaviors. The prognoses of patients in 3+4 group and 4+3 group are different after operation. It is quite feasible to further classify the patients with Gleason 7 according to major grades.
ABSTRACT
Objective:To compare the clinical characteristics of patients with Gleason score 3+4 and Gleason score 4+3 after radical prostatectomy for prostate cancer.Methods: The clinical records of patients who underwent radical retropubic prostatectomy in our hospital from 2001 to 2006 were retrospectively analyzed.Thirty-seven patients with a Gleason score of 7 after operation were divided into 2 groups,Gleason score 3+4 group and Gleason score 4+3 group,according to major grading.The patients were followed up for biochemical recurrence and distant metastases.Radioimmunoassay was used to detect the serum prostate-specific antigen(PSA) level.Kaplan-Meier method was used to compare the progression-free survival curves and Cox regression model was used to analyze the independent factors influencing the disease progression.Results: The rates of extraprostatic extension at radical prostatectomy were not significantly different between 3+4 and 4+3 groups(21.1% vs 33.3%,P=0.462).The non-progression survival time of 3+4 group was markedly longer than that of 4+3 group(P=0.030).Cox regression model showed that Gleason primary grade was an independent factor of prognosis(P=0.033).4+ 3 group had a higher risk for biochemical recurrence.Conclusion: Prostate cancers of Gleason score 7 with different grades have different biologic behaviors.The prognoses of patients in 3+4 group and 4+3 group are different after operation.It is quite feasible to further classify the patients with Gleason 7 according to major grades.