Journal article
Does Subclassification of Pathologically Organ Confined (pT2) Prostate Cancer Provide Prognostic Discrimination of Outcomes after Radical Prostatectomy?
- Nguyen DP Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, University of Bern, Bern, Switzerland.
- Vertosick EA Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
- Sharma V Department of Urology, Mayo Clinic, Rochester, Minnesota.
- Corradi RB Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Mario Penna Cancer Institute, Belo Horizonte, Brazil.
- Vilaseca A Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Urology Service, Hospital Clinic de Barcelona, Barcelona, Spain.
- Takeda T Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Keio University School of Medicine, Tokyo, Japan.
- Sjoberg DD Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
- Benfante N Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
- Fine SW Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
- Reuter VE Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
- Scardino PT Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
- Eastham JA Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
- Karnes RJ Department of Urology, Mayo Clinic, Rochester, Minnesota.
- Touijer KA Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York. Electronic address: touijerk@mskcc.org.
- 2018-01-09
Published in:
- The Journal of urology. - 2018
mortality
neoplasm metastasis
neoplasm staging
prostatectomy
prostatic neoplasms
Aged
Disease-Free Survival
Humans
Male
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local
Neoplasm Staging
Predictive Value of Tests
Prognosis
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Retrospective Studies
English
PURPOSE
We tested the latest update in the prostate cancer staging system by assessing the prognostic association of pT2 subclassification with the probability of survival related outcomes in patients who underwent radical prostatectomy.
MATERIALS AND METHODS
We retrospectively analyzed the records of a total of 15,305 patients who underwent radical prostatectomy at 2 referral centers between 1985 and 2016, and had pT2 disease at the final pathological evaluation. Descriptive statistics were used to compare baseline data stratified by pT2 substages (pT2a/b vs pT2c). Cox regression models were adjusted for institution analyzed differences in the rate of biochemical recurrence, metastasis, cancer specific death and overall mortality. Multivariable Cox regression models were used to evaluate the predictive value of pT2 subclassification for survival, including the linear predictor from the Stephenson nomogram.
RESULTS
Prostate specific antigen levels and Gleason score differed significantly between the pT2 substages (each p <0.0001). At a median followup of 6.0 years (IQR 3.3-10.1) 2,083 patients had biochemical recurrence, 161 had metastases, 43 had died of prostate cancer and 1,032 had died of another cause. On univariate analysis the pT2 subclassification was significantly associated with biochemical recurrence (p = 0.001) and distant metastasis (p = 0.033) but not with cancer specific death (p = 0.6) or overall mortality (p = 0.3). Multivariable analysis showed no evidence of a significant association between the pT2 subclassification and biochemical recurrence (p = 0.4) or distant metastasis (p = 0.6). Multivariable analysis of cancer specific death and overall mortality was omitted due to lack of significance on univariate analysis.
CONCLUSIONS
Subclassification of pT2 prostate cancer is not a prognostic indicator of survival related outcomes after radical prostatectomy. Our results validate the elimination of pT2 substages in the updated staging system.
We tested the latest update in the prostate cancer staging system by assessing the prognostic association of pT2 subclassification with the probability of survival related outcomes in patients who underwent radical prostatectomy.
MATERIALS AND METHODS
We retrospectively analyzed the records of a total of 15,305 patients who underwent radical prostatectomy at 2 referral centers between 1985 and 2016, and had pT2 disease at the final pathological evaluation. Descriptive statistics were used to compare baseline data stratified by pT2 substages (pT2a/b vs pT2c). Cox regression models were adjusted for institution analyzed differences in the rate of biochemical recurrence, metastasis, cancer specific death and overall mortality. Multivariable Cox regression models were used to evaluate the predictive value of pT2 subclassification for survival, including the linear predictor from the Stephenson nomogram.
RESULTS
Prostate specific antigen levels and Gleason score differed significantly between the pT2 substages (each p <0.0001). At a median followup of 6.0 years (IQR 3.3-10.1) 2,083 patients had biochemical recurrence, 161 had metastases, 43 had died of prostate cancer and 1,032 had died of another cause. On univariate analysis the pT2 subclassification was significantly associated with biochemical recurrence (p = 0.001) and distant metastasis (p = 0.033) but not with cancer specific death (p = 0.6) or overall mortality (p = 0.3). Multivariable analysis showed no evidence of a significant association between the pT2 subclassification and biochemical recurrence (p = 0.4) or distant metastasis (p = 0.6). Multivariable analysis of cancer specific death and overall mortality was omitted due to lack of significance on univariate analysis.
CONCLUSIONS
Subclassification of pT2 prostate cancer is not a prognostic indicator of survival related outcomes after radical prostatectomy. Our results validate the elimination of pT2 substages in the updated staging system.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.juro.2017.12.056
- PMID 29307681
- Persistent URL
- https://sonar.ch/global/documents/440
Statistics
Document views: 23
File downloads: