Re-stratification of Patients with High-Risk Prostate Cancer According to the NCCN Guidelines among Patients Who Underwent Radical Prostatectomy: An Analysis Based on the K-CaP Registry
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Purpose The present study aimed to re-stratify patients with high-risk prostate cancer according to the National Comprehensive Cancer Network guidelines among patients who underwent radical prostatectomy (RP). Materials and Methods This study used the Korean Prostate Cancer Database registry and identified 1,060 patients with high-risk prostate cancer who underwent RP between May 2001 and April 2013. All patients were categorized into risk groups, and subgroups were identified according to the type and number of high-risk factors. Results Of the 1,060 high-risk patients, 599 (56.5%), 408 (38.5%), and 53 (5.0%) had 1, 2, and 3 risk factors, respectively. In multivariate analysis, the Gleason score, percentage of positive biopsy cores, and number of risk factors present were identified as independent predictors of biochemical recurrence. There were significant differences in the 5-year postoperative biochemical failure-free survival (BCFFS) rate among the different high-risk factor subgroups (log-rank p < 0.001). There were no significant differences in the BCFFS rate between the subgroup of high-risk patients with a prostate-specific antigen level > 20 ng/mL alone and the intermediate-risk group with all factors (log-rank p=0.919 and p=0.781, respectively). Additionally, no significant difference was noted in the BCFFS rate between high-risk patients having all factors and those in the very-high-risk group (p=0.566). Conclusion We successfully re-stratified patients with high-risk prostate cancer and identified the combinations of high-risk criteria that will help in the selection of patients for RP.
Abstract
Purpose The present study aimed to re-stratify patients with high-risk prostate cancer according to the National Comprehensive Cancer Network guidelines among patients who underwent radical prostatectomy (RP). Materials and Methods This study used the Korean Prostate Cancer Database registry and identified 1,060 patients with high-risk prostate cancer who underwent RP between May 2001 and April 2013. All patients were categorized into risk groups, and subgroups were identified according to the type and number of high-risk factors. Results Of the 1,060 high-risk patients, 599 (56.5%), 408 (38.5%), and 53 (5.0%) had 1, 2, and 3 risk factors, respectively. In multivariate analysis, the Gleason score, percentage of positive biopsy cores, and number of risk factors present were identified as independent predictors of biochemical recurrence. There were significant differences in the 5-year postoperative biochemical failure-free survival (BCFFS) rate among the different high-risk factor subgroups (log-rank p < 0.001). There were no significant differences in the BCFFS rate between the subgroup of high-risk patients with a prostate-specific antigen level > 20 ng/mL alone and the intermediate-risk group with all factors (log-rank p=0.919 and p=0.781, respectively). Additionally, no significant difference was noted in the BCFFS rate between high-risk patients having all factors and those in the very-high-risk group (p=0.566). Conclusion We successfully re-stratified patients with high-risk prostate cancer and identified the combinations of high-risk criteria that will help in the selection of patients for RP.
참고문헌 (25)
- Heidenreich A, "EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intentupdate 2013", Eur Urol, 65, pp.124~137 (2014)[DOI]
- "Cancer statistics", JAMA, 310, pp.982~ (2013)[DOI]
- Chung BH, "The role of radical prostatectomy in high-risk prostate cancer", Prostate Int, 1, pp.95~101 (2013)[DOI]
- 오창모, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2013", Cancer Research and Treatment, 48(2), pp.436~450 (2016), 대한암학회
- Carter HB, "Early detection of prostate cancer: AUA guideline", J Urol, 190, pp.419~426 (2013)[DOI]
- Muralidhar V, "Definition and validation of "favorable high-risk prostate cancer": implications for personalizing treatment of radiation-managed patients", Int J Radiat Oncol Biol Phys, 93, pp.828~835 (2015)[DOI]
- Nguyen PL, "Predicting prostate cancer mortality among men with intermediate to high-risk disease and multiple unfavorable risk factors", Int J Radiat Oncol Biol Phys, 73, pp.659~664 (2009)[DOI]
- Kobayashi T, "Subclassification of high-risk clinically organ-confined prostate cancer for early cancer-specific mortality after radical prostatectomy", Jpn J Clin Oncol, 46, pp.762~767 (2016)[DOI]
- Mohler JL, "Prostate cancer, version 1.2016", J Natl Compr Canc Netw., 14, pp.19~30 (2016)[DOI]
- D'Amico AV, "Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer", JAMA, 280, pp.969~974 (1998)[DOI]
- Dong Hoon Lee, "The Establishment of K-CaP (the Multicenter Korean Prostate Cancer Database)", Korean Journal of Urology, 54(4), pp.229~ (2013), The Korean Urological Association (KAMJE)[DOI]
- Kattan MW, "A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer", J Natl Cancer Inst, 90, pp.766~771 (1998)[DOI]
- Cooperberg MR, "The University of California, San Francisco Cancer of the Prostate Risk Assessment score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy", J Urol, 173, pp.1938~1942 (2005)[DOI]
- Bolla M, "Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911)", Lancet, 380, pp.2018~2027 (2012)[DOI]
- Wiegel T, "Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02", AUO AP 09, J Clin Oncol, pp.2009, 27[DOI]
- Dorff TB, "Adjuvant androgen deprivation for highrisk prostate cancer after radical prostatectomy: SWOG S9921 study", J Clin Oncol, 29, pp.2040~2045 (2011)[DOI]
- Yossepowitch O, "Radical prostatectomy for clinically localized, high risk prostate cancer: critical analysis of risk assessment methods", J Urol, 178, pp.493~499 (2007)[DOI]
- Yossepowitch O, "Secondary therapy, metastatic progression, and cancer-specific mortality in men with clinically highrisk prostate cancer treated with radical prostatectomy", Eur Urol, 53, pp.950~959 (2008)[DOI]
- Joniau S, "Stratification of high-risk prostate cancer into prognostic categories: a European multi-institutional study", Eur Urol, 67, pp.157~164 (2015)[DOI]
- Jo JK, "Stratification of contemporary patients undergoing radical prostatectomy for high-risk prostate cancer", Ann Surg Oncol, 22, pp.2088~2093 (2015)[DOI]
- Walz J, "Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy", BJU Int, 107, pp.765~770 (2011)[DOI]
- Spahn M, "Outcome predictors of radical prostatectomy in patients with prostate-specific antigen greater than 20 ng", ml: a European multi-institutional study of 712 patients, 2010, pp.58, 1~7
- Sundi D, "Very-high-risk localized prostate cancer: definition and outcomes", Prostate Cancer Prostatic Dis, 17, pp.57~63 (2014)[DOI]
- Reese AC, "Contemporary evaluation of the National Comprehensive Cancer Network prostate cancer risk classification system", Urology, 80, pp.1075~1079 (2012)[DOI]
- Lughezzani G, "Multicenter European external validation of a prostate health index-based nomogram for predicting prostate cancer at extended biopsy", Eur Urol, 66, pp.906~912 (2014)[DOI]