癌症扩散到前列腺以外,包括前列腺外延伸(EPE)/显微镜下膀胱颈侵犯(mBNI)和精囊侵犯(SVI)目前分类为pT3a和pT3b病变,分别,并不一致地表明肿瘤预后不良。因此,需要对当前pT3疾病进行准确的风险分层。我们在此进一步确定了病理学家常规评估和报告的这些组织病理学病变的预后影响。尤其是他们的组合。我们评估了连续2,892例接受根治性前列腺切除术的患者的当前pT2(n=1,692),pT3a(n=956),或pT3b(n=244)疾病在我们机构2009年至2018年之间。根据我们的初步发现,给出了以下几点(1个点到焦点-EPE,mBNI,或单侧SVI;2点指向非病灶/已建立的EPE或双侧SVI),并在每种情况下进行总结。我们的队列有0分(n=1,692,58.5%;P0),1分(n=243,8.4%;P1),2分(n=657,22.7%;P2),3分(n=192,6.6%;P3),4分(n=76,2.6%;P4),和5分(n=32,1.1%;P5)。单变量分析显示,较高的点与显着较差的生化无进展生存期相关,特别是当P4和P5合并时。在多变量分析中(P0作为参考),P1[危险比(HR)=1.57,P=0.033],P2(HR=3.25,P<0.001),P3(HR=4.01,P<0.001),和P4+P5(HR=5.99,P<0.001)显示术后进展风险显著。同时,Harrell的当前pT暂存的c索引,新开发的点系统,CAPRA-S评分为0.727[95%置信区间(CI)0.706-0.748],0.751(95%CI0.729-0.773),和0.774(95%CI0.755-0.794),分别,预测进展。我们相信我们的数据为基于求和点的新型病理T分期系统提供了逻辑原理,pT1a(0点),pT1b(1分),pT2(2分),pT3a(3分),和pT3b(4或5分),从而更准确地对前列腺癌的预后进行分层。
Cancer spread beyond the prostate, including extraprostatic extension (other than seminal vesicle or bladder invasion; EPE)/microscopic bladder neck invasion and seminal vesicle invasion (SVI) currently classified as pT3a and pT3b lesions, respectively, does not uniformly indicate poor oncologic outcomes. Accurate risk stratification of current pT3 disease is therefore required. We herein further determined the prognostic impact of these histopathologic lesions routinely assessed and reported by pathologists, particularly their combinations. We assessed consecutive 2892 patients undergoing radical prostatectomy for current pT2 (n = 1692), pT3a (n = 956), or pT3b (n = 244) disease at our institution between 2009 and 2018. Based on our preliminary findings, point(s) were given (1 point to focal EPE, microscopic bladder neck invasion, or unilateral SVI; 2 points to nonfocal/established EPE or bilateral SVI) and summed up in each case. Our cohort had 0 point (n = 1692, 58.5%; P0), 1 point (n = 243, 8.4%; P1), 2 points (n = 657, 22.7%; P2), 3 points (n = 192, 6.6%; P3), 4 points (n = 76, 2.6%; P4), and 5 points (n = 32, 1.1%; P5). Univariate analysis revealed associations of higher points with significantly worse biochemical progression-free survival, particularly when P4 and P5 were combined. In multivariable analysis (P0 as a reference), P1 (hazard ratio [HR], 1.57; P = .033), P2 (HR, 3.25; P < .001), P3 (HR, 4.01; P < .001), and P4 + P5 (HR, 5.99; P < .001) showed significance for the risk of postoperative progression. Meanwhile, Harrell C-indexes for the current pT staging, newly developed point system, and the Cancer of the Prostate Risk Assessment post-Surgical (CAPRA-S) score were 0.727 (95% CI, 0.706-0.748), 0.751 (95% CI, 0.729-0.773), and 0.774 (95% CI, 0.755-0.794), respectively, for predicting progression. We believe our data provide a logical rationale for a novel pathologic T-staging system based on the summed points, pT1a (0 point), pT1b (1 point), pT2 (2 points), pT3a (3 points), and pT3b (4 or 5 points), which more accurately stratifies the prognosis of prostate cancer.