Abstract：
BACKGROUND: To test for differences in organ-confined pathological tumor stage (pT) and intermediate International Society of Urological Pathologists (ISUP) grade vs. nonorgan confined pT stage and high ISUP grade and biochemical recurrence (BCR) after radical prostatectomy (RP).
METHODS: Relying on a tertiary-care database, prostate cancer patients undergoing RP between January 2014 and December 2021 were stratified according to their combination of pT stage and ISUP grade in RP specimens (pT2 ISUP4/5 vs. pT3/4 ISUP2 vs. pT3/4 ISUP3). As Active Surveillance is recommended in ISUP1, these patients were excluded. Moreover, patients with pT2 ISUP2/3 are known for their good prognosis and pT3/4 ISUP4/5 patients for their poor prognosis. Therefore, these patients were also excluded from analyses. Kaplan-Meier survival analyses and multivariable Cox regression models addressed BCR after RP.
RESULTS: Of 215 RP patients, 29 (13%) exhibited pT2 ISUP4/5 vs. 122 (57%) pT3/4 ISUP2 vs. 64 (30%) pT3/4 ISUP3 pathology. In survival analyses, 3-year BCR-free survival rates were 95% in pT2 ISUP4/5 vs. 88% in pT3/4 ISUP2 vs. 65% in pT3/4 ISUP3 patients (P < 0.001). In multivariable Cox regression models addressing BCR, pT3/4 ISUP3 pathology was associated with higher BCR rate relative to pT2 ISUP4/5 pathology (hazard ratio 3.42, 95% confidence interval 1.07-10.94; P = 0.039), but not pT3/4 ISUP2 pathology (P = 0.6).
CONCLUSIONS: Compared to prostate cancer patients with pT2 ISUP4/5 pathology, the combination of pT3/4 ISUP3 pathology is associated with higher risk of BCR after RP. In consequence, patients with pT3/4 ISUP3 pathology should be considered for a closer postoperative follow-up.
METHODS: Relying on a tertiary-care database, prostate cancer patients undergoing RP between January 2014 and December 2021 were stratified according to their combination of pT stage and ISUP grade in RP specimens (pT2 ISUP4/5 vs. pT3/4 ISUP2 vs. pT3/4 ISUP3). As Active Surveillance is recommended in ISUP1, these patients were excluded. Moreover, patients with pT2 ISUP2/3 are known for their good prognosis and pT3/4 ISUP4/5 patients for their poor prognosis. Therefore, these patients were also excluded from analyses. Kaplan-Meier survival analyses and multivariable Cox regression models addressed BCR after RP.
RESULTS: Of 215 RP patients, 29 (13%) exhibited pT2 ISUP4/5 vs. 122 (57%) pT3/4 ISUP2 vs. 64 (30%) pT3/4 ISUP3 pathology. In survival analyses, 3-year BCR-free survival rates were 95% in pT2 ISUP4/5 vs. 88% in pT3/4 ISUP2 vs. 65% in pT3/4 ISUP3 patients (P < 0.001). In multivariable Cox regression models addressing BCR, pT3/4 ISUP3 pathology was associated with higher BCR rate relative to pT2 ISUP4/5 pathology (hazard ratio 3.42, 95% confidence interval 1.07-10.94; P = 0.039), but not pT3/4 ISUP2 pathology (P = 0.6).
CONCLUSIONS: Compared to prostate cancer patients with pT2 ISUP4/5 pathology, the combination of pT3/4 ISUP3 pathology is associated with higher risk of BCR after RP. In consequence, patients with pT3/4 ISUP3 pathology should be considered for a closer postoperative follow-up.
摘要：
背景：为了测试器官局限的病理肿瘤分期（pT）和中级国际泌尿外科病理学家学会（ISUP）分级与前列腺癌根治术（RP）后非器官狭窄的pT分期和高ISUP分级和生化复发（BCR）。
方法：依靠三级护理数据库，2014年1月至2021年12月期间接受RP的前列腺癌患者根据RP标本中pT分期和ISUP分级的组合进行分层(pT2ISUP4/5vs.pT3/4ISUP2vs.pT3/4ISUP3)。由于ISUP1中建议进行主动监测，因此排除了这些患者。此外，pT2ISUP2/3患者预后良好,pT3/4ISUP4/5患者预后不良.因此,这些患者也被排除在分析之外.Kaplan-Meier生存分析和多变量Cox回归模型解决了RP后BCR。
结果：在215例RP患者中，29（13％）显示pT2ISUP4/5与122（57％）pT3/4ISUP2与64(30%)pT3/4ISUP3病理。在生存分析中，pT2ISUP4/5的3年无BCR生存率为95％。88%的pT3/4ISUP2与在pT3/4ISUP3患者中为65%(P<0.001)。在解决BCR的多变量Cox回归模型中，相对于pT2ISUP4/5病理学，pT3/4ISUP3病理学与较高的BCR率相关（风险比3.42，95％置信区间1.07-10.94；P=0.039），而不是pT3/4ISUP2病理（P=0.6）。
结论：与pT2ISUP4/5病理的前列腺癌患者相比，pT3/4ISUP3病理的组合与RP后BCR的高风险相关。因此，有pT3/4ISUP3病理的患者应考虑进行更密切的术后随访.
方法：依靠三级护理数据库，2014年1月至2021年12月期间接受RP的前列腺癌患者根据RP标本中pT分期和ISUP分级的组合进行分层(pT2ISUP4/5vs.pT3/4ISUP2vs.pT3/4ISUP3)。由于ISUP1中建议进行主动监测，因此排除了这些患者。此外，pT2ISUP2/3患者预后良好,pT3/4ISUP4/5患者预后不良.因此,这些患者也被排除在分析之外.Kaplan-Meier生存分析和多变量Cox回归模型解决了RP后BCR。
结果：在215例RP患者中，29（13％）显示pT2ISUP4/5与122（57％）pT3/4ISUP2与64(30%)pT3/4ISUP3病理。在生存分析中，pT2ISUP4/5的3年无BCR生存率为95％。88%的pT3/4ISUP2与在pT3/4ISUP3患者中为65%(P<0.001)。在解决BCR的多变量Cox回归模型中，相对于pT2ISUP4/5病理学，pT3/4ISUP3病理学与较高的BCR率相关（风险比3.42，95％置信区间1.07-10.94；P=0.039），而不是pT3/4ISUP2病理（P=0.6）。
结论：与pT2ISUP4/5病理的前列腺癌患者相比，pT3/4ISUP3病理的组合与RP后BCR的高风险相关。因此，有pT3/4ISUP3病理的患者应考虑进行更密切的术后随访.
