- Email: [email protected]
418 Risk of mestastatic progression depends on time to biochemical failure following radical and clinic-pathologic factors following radical prostatectomy
418
Risk of mestastatic progression depends on time to biochemical failure following radical and clinic-pathologic factors following radical prostatectomy Eur Urol Suppl 2014;13;e418
Print! Print!
Ramirez Backhaus M., Rubio-Briones J., Dominguez-Escrig J.L., Casanova J., Collado-Serra A., Dumont R., Gomez-Ferrer A., Iborra I., Monros J.L., Ricos J.V., Solsona E. Fundación Instituto Valenciano de Oncología, Dept. of Urology, Valencia, Spain INTRODUCTION & OBJECTIVES: Although radical prostatectomy is a curative-intent therapy, a significant number of patients suffer biochemical relapse. Many attempts have been made to understand the natural history of prostate cancer after biochemical failure but assessment is impaired by the number of variables and other confounding factors. We analyse the relationship between biochemical recurrence and metastasis free survival, adjusting by clinico-pathological variables, in order to identify patients with low risk of progression, thus, candidates for an early discharge MATERIAL & METHODS: Prospectively collected data from 932 patients, operated before 1/1/2008, is included in the current analysis. Patients receiving neo-adjuvant hormonal therapy are excluded. No patients received immediate hormonal deprivation or adjuvant radiothepay in the first 3 months after surgery. Clinico-pathologic risk factors for metastatic progression were assessed by means of Cox proportional hazards models, defining 3 differentiated risk groups. Subset analysis calculating the 10-year biochemical and metastasis free survival (BFS and MFS) with 95% confidence interval (CI95%) was performed in 5 subgroups of patients: those free of biochemical progression after 1, 2, 3, 4 and 5 years of follow-up. Kaplan-Meyer curves were calculated for each subgroup and adjusted by the previously defined clinico-pathologic risk groups. Biochemical failire was defined as PSA> 0,4 ng/ml. and metastasis as the presence of bone, visceral or extra-pelvic nodal disease. The significance level was 0.05 for all statistical tests and analysis was performed using SAS version 9.1 (SAS Institute, Cary, NC, USA). RESULTS:
A total of 827 patients were included in the study. Clinico-pathological characteristics of the sample showed a 14,9% of patients with PSA above 20, 45,1% with a pathological Gleason score ≥7, 42,2% of pT3-4 patients and 9% of N1. PSA>20, Gleason score ≥8, pT≥3 and N1 were independently associated with metastasis. Three risk groups were defined depending on the presence of: none, one or ≥2 risk factors. With a median follow-up 8,6 years, 343 (41,5%) suffer biochemical relapse and 82 (9,9%) developed metastasis. The 10 years BFS was 53,3% (IC95%CI 49,3-57,3) and the 10 years MFS was 88,9% (IC95% 86,2-91,6). In patients free of biochemical relapse 5 years after the surgery and no clinico-pathological risk factors, 15yBFS was 82,4% and 15yMFS 97,1%. In contrast, whereas BFS and MFS were 45,3% and 75,1%, respectively, if 2 risk factors were present. Image 1 CONCLUSIONS: Patients without clinico-pathological risk factors and free of biochemical relapse after 5 years, will have a low risk of biochemical and metastatic progression in the next 10 years and could be considered for an early discharge
Risk of mestastatic progression depends on time to biochemical failure following radical and clinic-pathologic factors following radical prostatectomy Eur Urol Suppl 2014;13;e418
Print! Print!
Ramirez Backhaus M., Rubio-Briones J., Dominguez-Escrig J.L., Casanova J., Collado-Serra A., Dumont R., Gomez-Ferrer A., Iborra I., Monros J.L., Ricos J.V., Solsona E. Fundación Instituto Valenciano de Oncología, Dept. of Urology, Valencia, Spain INTRODUCTION & OBJECTIVES: Although radical prostatectomy is a curative-intent therapy, a significant number of patients suffer biochemical relapse. Many attempts have been made to understand the natural history of prostate cancer after biochemical failure but assessment is impaired by the number of variables and other confounding factors. We analyse the relationship between biochemical recurrence and metastasis free survival, adjusting by clinico-pathological variables, in order to identify patients with low risk of progression, thus, candidates for an early discharge MATERIAL & METHODS: Prospectively collected data from 932 patients, operated before 1/1/2008, is included in the current analysis. Patients receiving neo-adjuvant hormonal therapy are excluded. No patients received immediate hormonal deprivation or adjuvant radiothepay in the first 3 months after surgery. Clinico-pathologic risk factors for metastatic progression were assessed by means of Cox proportional hazards models, defining 3 differentiated risk groups. Subset analysis calculating the 10-year biochemical and metastasis free survival (BFS and MFS) with 95% confidence interval (CI95%) was performed in 5 subgroups of patients: those free of biochemical progression after 1, 2, 3, 4 and 5 years of follow-up. Kaplan-Meyer curves were calculated for each subgroup and adjusted by the previously defined clinico-pathologic risk groups. Biochemical failire was defined as PSA> 0,4 ng/ml. and metastasis as the presence of bone, visceral or extra-pelvic nodal disease. The significance level was 0.05 for all statistical tests and analysis was performed using SAS version 9.1 (SAS Institute, Cary, NC, USA). RESULTS:
A total of 827 patients were included in the study. Clinico-pathological characteristics of the sample showed a 14,9% of patients with PSA above 20, 45,1% with a pathological Gleason score ≥7, 42,2% of pT3-4 patients and 9% of N1. PSA>20, Gleason score ≥8, pT≥3 and N1 were independently associated with metastasis. Three risk groups were defined depending on the presence of: none, one or ≥2 risk factors. With a median follow-up 8,6 years, 343 (41,5%) suffer biochemical relapse and 82 (9,9%) developed metastasis. The 10 years BFS was 53,3% (IC95%CI 49,3-57,3) and the 10 years MFS was 88,9% (IC95% 86,2-91,6). In patients free of biochemical relapse 5 years after the surgery and no clinico-pathological risk factors, 15yBFS was 82,4% and 15yMFS 97,1%. In contrast, whereas BFS and MFS were 45,3% and 75,1%, respectively, if 2 risk factors were present. Image 1 CONCLUSIONS: Patients without clinico-pathological risk factors and free of biochemical relapse after 5 years, will have a low risk of biochemical and metastatic progression in the next 10 years and could be considered for an early discharge