Comparing survival outcomes of patients with different time intervals between puncture and radical resection for prostate cancer
Objective To investigate the differences in short-term postoperative complications and long-term survival prognosis in patients with different time interval between prostate needle biopsy and radical prostatectomy(RP).Methods The clinical data of 185 patients who underwent RP at the department of urology,Wuhan Union hospital between May 2014 and May 2019 were analyzed retrospectively.According to the time interval between biopsy and RP,they were divided into ≤2 weeks and ≥4 weeks group.Among them,103 cases underwent RP within 2 weeks with age of 67(63,73)years old,with BMI of 23.66(22.17,25.44)kg/m2,hypertension in 40 cases(38.8％),diabetes in 13 cases(12.7％),and diagnosed PSA of 20.63(11.88,48.50)ng/ml,including 53 cases(51.0％)above 20 ng/ml.The f/t PSA value was 0.1(0.07,0.15),with 30(29.1％)cases of biopsy Gleason score ≥8,and 73(70.9％)cases undergoing RARP.In 39 cases(37.8％),the radical Gleason score was ≥8,and 69(67.0％)cases were pathologically staged Ⅲ-Ⅳ.There were 82 cases undergoing RP after 4 weeks,with age of 67(62,69)years old,BMI of 23.56(21.73,24.91)kg/m2,hypertension in 35 cases(42.7％),diabetes in 11 cases(13.4％)and diagnosed PSA of 20.84(14.38,46.25)ng/ml,including 43 cases(52.0％)above 20 ng/ml.The f/t PSA value was 0.12(0.10,0.15),with 27(32.9％)cases of biopsy Gleason score ≥8,and 66(80.5％)cases undergoing RARP.In 41 cases(50.0％),the radical Gleason score was ≥8,and 58(70.7％)cases were pathologically staged Ⅲ-Ⅳ.To reduce data bias and confounding factors,71 pairs of comparable cases were obtained after propensity score matching(PSM)based on patient age,BMI,hypertension,diabetes,total prostate-specific antigen(TPSA)value,Gleason score,and surgical modality,with no statistically significant differences between the two groups at baseline.The differences in blood loss,duration of surgery,postoperative hospital stay,positive margins,and urinary incontinence between the two groups were determined using SPSS 26 software.The variation in overall survival rate(OS),progression-free survival rate(PFS)and disease-specific survival rate(DSS)among the two groups and independent risk factors were also assessed by Kaplan-Meier curves and Cox regression,and finally high risk subgroup survival differences between the two groups were evaluated according to PSA ≥ 20,radical Gleason score ≥ 8 and pathological stage Ⅲ-Ⅳ,respectively.Results There were 185 patients being obtained after screening,with 71 pairs remaining after matching,of which 130 had complete survival information.The median follow-up time was 52(39,71)months.Patients in the ≤2 weeks group had an operative time of 244(186,252)min and blood loss of 137(87,300)ml,with no statistically significant differences compared with 246(186,288)min and 108(68,228)ml in the ≥4-weeks group.The rate of positive margins were 40.8％in both groups(P=1.000).Urinary incontinence rates were[14(19.7％)and 18(25.0％),P=0.541],respectively.The results of survival analysis showed that the 5-year DSS rates of patients in the ≤ 2-week group and ≥4-week group were 83.1％and 98.4％,respectively(P=0.023).Univariate Cox regression analysis showed that Gleason score ≥8(HR=18.439,95％CI 2.262-150.337,P=0.01)and positive margin(HR=12.041,95％CI=1.477-98.174,P=0.02)were independent risk factors for DSS.The results of subgroup analysis among radical score ≥8 showed that the 5-year OS of the ≤ 2-week group and the ≥4-week group were 54.6％and 95.8％(P=0.021),and the DSS was 54.6％and 95.8％,respectively(P=0.021).Among patients with PSA ≥20 ng/ml,the OS were 54.6％and 95.8％(P=0.028),and the DSS rates were 72.5％and 100.0％(P=0.008).Among patients with pathologically staged Ⅲ-Ⅳ,the OS were 53.9％and 92.3％(P=0.045),and the DSS rates were 53.9％and 96.1％(P=0.014).Conclusions Compared with an interval of ≤2 weeks,there was no significant difference in the incidence of complications such as blood loss,positive margins and urinary incontinence when RP was performed at an interval of ≥4 weeks.However,a better DSS was observed in time interval ≥4 weeks patients.Especially,for the high-risk prostate cancer,both OS and DSS were improved in ≥4 weeks group.
万方数据
维普
