Disease-specific outcomes of Radical Prostatectomies in Northern Norway; a case for the impact of perineural infiltration and postoperative PSA-doubling time

BMC Urology

Research Article

Khalid Al-Shibli¹  Øystein Størkersen²  Helena Bertilsson³  Anders Angelsen³  Roy M Bremnes⁴  Sigve Andersen⁴  Tom Donnem⁴  Yngve Nordby⁵  Nora Ness⁶  Lill-Tove Busund⁷  Elin Richardsen⁷ 

[1] Department Pathology, Nordland Hospital, Bodoe, Norway;Department Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;Department of Urology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;Institute of Cancer research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway;Institute of Clinical Medicine, The Arctic University of Norway, Tromso, Norway;Department Oncology, University Hospital of North Norway, 9038, Tromso, Norway;Institute of Clinical Medicine, The Arctic University of Norway, Tromso, Norway;Department of Urology, University Hospital of North Norway, Tromso, Norway;Institute of Medical Biology, The Arctic University of Norway, Tromso, Norway;Institute of Medical Biology, The Arctic University of Norway, Tromso, Norway;Department Pathology, University Hospital of North Norway, Tromso, Norway;

关键词: Radical Prostatectomy;    Gleason Score;    Positive Surgical Margin;    Clinical Failure;    Biochemical Failure;   

DOI  :  10.1186/1471-2490-14-49

 received in 2013-11-06, accepted in 2014-05-28,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundProstate cancer is the most common male malignancy and a mayor cause of mortality in the western world. The impact of clinicopathological variables on disease related outcomes have mainly been reported from a few large US series, most of them not reporting on perineural infiltration. We therefore wanted to investigate relevant cancer outcomes in patients undergoing radical prostatectomy in two Norwegian health regions with an emphasis on the impact of perineural infiltration (PNI) and prostate specific antigen- doubling time (PSA-DT).MethodsWe conducted a retrospective analysis of 535 prostatectomy patients at three hospitals between 1995 and 2005 estimating biochemical failure- (BFFS), clinical failure- (CFFS) and prostate cancer death-free survival (PCDFS) with the Kaplan-Meier method. We investigated clinicopathological factors influencing risk of events using cox proportional hazard regression.ResultsAfter a median follow-up of 89 months, 170 patients (32%) experienced biochemical failure (BF), 36 (7%) experienced clinical failure and 15 (3%) had died of prostate cancer. pT-Stage (p = 0.001), preoperative PSA (p = 0.047), Gleason Score (p = 0.032), non-apical positive surgical margins (PSM) (p = 0.003) and apical PSM (p = 0.031) were all independently associated to BFFS. Gleason score (p = 0.019), PNI (p = 0.012) and non-apical PSM (p = 0.002) were all independently associated to CFFS while only PNI (P = 0.047) and subgroups of Gleason score were independently associated to PCDFS. After BF, patients with a shorter PSA-DT had independent and significant worse event-free survivals than patients with PSA-DT > 15 months (PSA-DT = 3-9 months, CFFS HR = 6.44, p < 0.001, PCDFS HR = 13.7, p = 0.020; PSA-DT < 3 months, CFFS HR = 11.2, p < 0.001, PCDFS HR = 27.5, p = 0.006).ConclusionsAfter prostatectomy, CFFS and PCDFS are variable, but both are strongly associated to Gleason score and PNI. In patients with BF, PSA-DT was most strongly associated to CF and PCD. Our study adds weight to the importance of PSA-DT and re-launches PNI as a strong prognosticator for clinically relevant endpoints.

【 授权许可】

CC BY   
© Andersen et al.; licensee BioMed Central Ltd. 2014