攝護腺癌術後復發族群之兩年內生化復發危險因子探討

李宗叡、黃志平、張兆祥、吳錫金、葉進仲、楊啟瑞、陳冠亨

中國醫藥大學附設醫院 泌尿部

The risk factors analysis for the biochemical failure within two years for patients with PSA failure after robotic radical prostatectomy

Tzung-Ruei Li, Chi-Ping Huang, Chao-Hsiang Chang, Hsi-Chin Wu, Chin-Chung Yeh, Chi-Rei Yang, Kuan-Hen Chen

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Purpose:

The mainstream treatment of localized prostate cancer is radical prostatectomy. Some patients will need adjuvant treatment or further image study due to the recurrence, with first presentation of biochemical failure (PSA ≥ 0.2ng/ml). We aimed to identify the patients with risk of early biochemical failure.

Materials and Methods:

From Feb 2012 to March 2019, 538 patients received robotic radical prostatectomy with lymph nodes dissection. We included these patients whose PSA once revealed below 0.2ng/ml after surgery but then met biochemical failure, and we excluded the patients with initial metastasis, receiving neoadjuvant and/ or adjuvant radiotherapy or hormone therapy. We analyzed the PSA level and histological factors to figure the patients with risk of early biochemical failure. All the statistical analysis was performed with SPSS 25.0.

Results:

There were 89 patients with biochemical failure recruited, and the mean age was 66.57± 7.27 years old with mean iPSA 16.96±12.32. The mean biochemical failure-free duration was 23.52±18.71 months. 34.8%, 36%, 24.7%, 4.5% patients belonged to pT2, pT3a, pT3b and pT4 stage, respectively. For the Gleason score grade, 1 patient showed group 1, while 53.9%, 44.9% belonged to grade group 2- 3, and 4 -5, respectively. 59.6% (53/89) patients showed margin positive. 21.3% (19/89) patients with positive regional lymph nodes. 23.6% (21/89) patients with lympho-vascular invasion. We defined early biochemical failure group whose PSA ≥ 0.2ng/ml within two years after surgery. Further analysis showed patients with early biochemical failure had significantly large estimated tumor volume (11.87cm³ v.s. 6.02 cm³, p=0.002), and high correlation to unable to reach undetectable nadir PSA (PSA<0.008) (p<0.001), locally advanced pT stage (p<0.001), margin positive (p=0.023), positive regional lymph nodes (p=0.039) after chi-square test. Further ROC analysis for early biochemical failure in these group showed nadir PSA had area under curve 0.77, with the cut off value of 0.016.

Conclusions:

Our result indicates that patients who do not have undetectable nadir PSA, larger tumor volume, locally advanced T stage, positive margin and lymph node dissection, have higher risks of early biochemical failure, and hence need further adjuvant treatment.