Oncologic Outcomes of Patients With Gleason Score 7 and Tertiary Gleason Pattern 5 After Radical Prostatectomy
Leng Yi-Hsueh, 이원준, 양승옥, 이정기, 정태영, 김윤범,
소속 상세정보
( Leng Yi-Hsueh )
Veterans Health Service Medical Center Department of Urology
이원준 ( Lee Won-Jun )
Veterans Health Service Medical Center Department of Urology
양승옥 ( Yang Seung-Ok )
Veterans Health Service Medical Center Department of Urology
이정기 ( Lee Jeong-Ki )
Veterans Health Service Medical Center Department of Urology
정태영 ( Jung Tae-Young )
Veterans Health Service Medical Center Department of Urology
김윤범 ( Kim Yun-Beom )
Veterans Health Service Medical Center Department of Urology
KMID : 0358320130540090587
Abstract
Purpose: We evaluated oncologic outcomes following radical prostatectomy (RP) in patients with a Gleason score (GS) of 7 with tertiary Gleason pattern 5 (TGP5). Materials and Methods: We retrospectively reviewed the medical records of 310 patients who underwent RP from 2005 to 2010. Twenty-four patients who received neoadjuvant or adjuvant antiandrogen deprivation or radiation therapy were excluded. Just 239 (GS 6 to 8) of the remaining 286 patients were included in the study. Patients were classified into four groups: GS 6, GS 7 without TGP5, GS 7 with TGP5, and GS 8. We analyzed preoperative clinical factors, postoperative pathological outcomes, and biochemical recurrence (BCR). Results: TGP5 in GS 7 was an independent predictor of primary Gleason pattern 4, tumor volume larger than 10%, positive surgical margin, and lymphovascular invasion. The presence of TGP5 in GS 7 was not associated with BCR-free survival. Subgroup analyses revealed that BCR-free survival did not differ significantly between patients with GS 7 with TGP5 and those with GS 8 (p=0.120). In addition, time to BCR in patients with a higher percentage of TGP5 was shorter than that in patients with a lower percentage of TGP5. TGP5 in GS 7 was not a significant predictive factor for BCR, whereas prostate-specific antigen density and a positive surgical margin were shown to be independent predictors of BCR. Conclusions: TGP5 in GS 7 was an independent predictor of unfavorable pathologic outcomes. The rate of BCR was similar in GS 7 disease with TGP5 and in GS 8 disease, even though TGP5 was not a significant predictive factor for BCR in Cox proportional hazards models.
키워드
Disease progression; Neoplasm grading; Prostatectomy
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