The association of type and number of high-risk criteria with cancer-specific mortality in prostate cancer patients treated with radical prostatectomy

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摘要Objectives:This study aimed to test the association between of type and number of D'Amico high-risk criteria(DHRCs)with cancer-specific mortality(CSM)in high-risk prostate cancer patients treated with radical prostatectomy.Materials and methods:In the Surveillance,Epidemiology,and End Results database(2004-2016),we identified 31,281 radical pros-tatectomy patients with at least 1 DHRC,namely,prostate-specific antigen(PSA)＞20 ng/mL(hrPSA),biopsy Gleason Grade Group(hrGGG)score of 4 and 5,or clinical tumor stage ≥T3(hrcT).Multivariable Cox regression models and competing risks regression models(adjusting for other cause mortality)tested the association between DHRCs and 5-year CSM.Results:Of 31,281 patients,14,394(67％)exclusively harbored hrGGG,3189(15％)harbored hrPSA,and 1781(8.2％)harbored hrcT.Only 2132 patients(6.8％)harbored a combination of the 2 DHRCs,and 138(0.6％)had all 3 DHRCs.Five-year CSM rates ranged from 0.9％to 3.0％when any individual DHRC was present(hrcT,hrPSA,and hrGGG,in that order),1.6％to 5.9％when 2 DHRCs were present(hrPSA-hrcT,hrcT-hrGGG,and hrPSA-hrGGG,in that order),and 8.1％when all 3 DHRCs were present.Cox regression models and competing risks regression confirmed the independent predictor status of DHRCs for 5-year CSM that was observed in univariable analyses,with hazard ratios from 1.00 to 2.83 for 1 DHRC,2.35 to 5.88 for combinations of 2 DHRCs,and 7.13 for all 3 DHRCs.Conclusions:Within individual DHRCs,hrcT and hrPSA exhibited weaker effects than hrGGG did.Moreover,a dose-response effect was identified according to the number of DHRCs.Accordingly,the type and number of DHRCs allow further risk stratification within the high-risk subgroup.

作者 Francesco Chierigo ^[1] Rocco Simone Flammia ^[2] Gabriele Sorce ^[3] Benedikt Hoeh ^[4] Lukas Hohenhorst ^[5] Andrea Panunzio ^[6] Zhe Tian ^[7] Fred Saad ^[8] Marcus Graefen ^[9] Michele Gallucci ^[10] Alberto Briganti ^[11] Francesco Montorsi ^[12] Felix K.H.Chun ^[13] Shahrokh F.Shariat Alessandro Antonelli Giovanni Guano Guglielmo Mantica Marco Borghesi Nazareno Suardi Carlo Terrone Pierre I.Karakiewicz 学术成果认领

作者单位 Department of Surgical and Diagnostic Integrated Sciences,University of Genova,Genova,Italy;IRCCS Ospedale Policlinico San Martino,Genova,Italy;Cancer Prognostics and Health Outcomes Unit,Division of Urology,University of Montréal Health Center,Montréal,Québec,Canada;Department of Urology,IRCCS Policlinico San Martino,Genova,Italy ^[1] Cancer Prognostics and Health Outcomes Unit,Division of Urology,University of Montréal Health Center,Montréal,Québec,Canada;Department of Maternal-Child and Urological Sciences,Sapienza Rome University,Policlinico Umberto I Hospital,Rome,Italy ^[2] Cancer Prognostics and Health Outcomes Unit,Division of Urology,University of Montréal Health Center,Montréal,Québec,Canada;Department of Urology,University Hospital Frankfurt,Frankfurt am Main,Germany ^[3] Cancer Prognostics and Health Outcomes Unit,Division of Urology,University of Montréal Health Center,Montréal,Québec,Canada;Martini-Klinik Prostate Cancer Center,University Hospital Hamburg-Eppendorf,Hamburg,Germany ^[4] Cancer Prognostics and Health Outcomes Unit,Division of Urology,University of Montréal Health Center,Montréal,Québec,Canada;Department of Urology,University of Verona,Azienda Ospedaliera Universitaria Integrata di Verona,Verona,Italy ^[5] Cancer Prognostics and Health Outcomes Unit,Division of Urology,University of Montréal Health Center,Montréal,Québec,Canada ^[6] Martini-Klinik Prostate Cancer Center,University Hospital Hamburg-Eppendorf,Hamburg,Germany ^[7] Department of Maternal-Child and Urological Sciences,Sapienza Rome University,Policlinico Umberto I Hospital,Rome,Italy ^[8] Division of Experimental Oncology/Unit of Urology,URI,Urological Research Institute,IRCCS San Raffaele Scientific Institute,Milan,Italy ^[9] Department of Urology,University Hospital Frankfurt,Frankfurt am Main,Germany ^[10] Department of Urology,Comprehensive Cancer Center,Medical University of Vienna,Vienna,Austria;Department of Urology,Weill Cornell Medical College,New York,NY,USA;Department of Urology,University of Texas Southwestern,Dallas,TX,USA;Department of Urology,Second Faculty of Medicine,Charles University,Prague,Czech Republic;Institute for Urology and Reproductive Health,I.M.Sechenov First Moscow State Medical University,Moscow,Russia;Division of Urology,Department of Special Surgery,Jordan University Hospital,The University of Jordan,Amman,Jordan ^[11] Department of Urology,University of Verona,Azienda Ospedaliera Universitaria Integrata di Verona,Verona,Italy ^[12] Department of Surgical and Diagnostic Integrated Sciences,University of Genova,Genova,Italy;Department of Urology,IRCCS Policlinico San Martino,Genova,Italy ^[13]

DOI 10.1097/CU9.0000000000000188

发布时间 2024-10-10