Clinical genitourinary cancer · 2025
Clinically Meaningful Upstaging and Upgrading in Favorable Intermediate-Risk Radical Prostatectomy Patients.
СтатьяНазвание и аннотация: Перевод в очереди
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Longoni Mattia, Di Bello Francesco, Rodriguez Peñaranda Natali, Falkenbach Fabian, Marmiroli Andrea, Le Quynh Chi, Tian Zhe, Goyal Jordan A, Longo Nicola, Puliatti Stefano, Graefen Markus, de Cobelli Ottavio, Chun Felix K H, Saad Fred, Shariat Shahrokh F, Gandaglia Giorgio, Montorsi Francesco, Briganti Alberto, Karakiewicz Pierre I
Аннотация
INTRODUCTION: In NCCN favorable intermediate-risk (FIR) prostate cancer (PCa) patients treated with radical prostatectomy (RP), we tested the effect of upstaging and upgrading on cancer-specific mortality (CSM).
METHODS: Within the SEER database (2010-2021), upstaging (≥pT3a or pN1) and upgrading (ISUP ≥3) rates in FIR RP patients were tabulated. Kaplan-Meier (KM) plots and multivariable Cox-regression models (CRMs) were fitted.
RESULTS: In 9,037 FIR RP PCa patients, 1,136 (12.6%) exhibited upstaging, 1,341 (14.8%) upgrading, and 377 (4.2%) both vs. 6,937 (76.8%) that did not. Of all upstaged patients, 812 (71.5%) harbored pT3a vs. 324 (28.5%) ≥pT3b/pN1 stage. Of all upgraded patients, 1,077 (80.3%) harbored ISUP 3 vs. 264 (19.7%) ISUP ≥4. Of all upstaged and upgraded patients, 46 (12.2%) exhibited both ≥pT3b/pN1 and ISUP ≥4. Ten-year CSM-free rates in upstaged (96.0%), upgraded (95.9%) and combined upstaged and upgraded (91.0%) patients were significantly lower (P < .001) than others (98.9%). Significantly lower 10-year CSM-free rates were recorded in ≥pT3b/pN1-only (91.9%), ISUP ≥4-only (94.6%), and combined ≥pT3b/pN1 and ISUP ≥4 (85.3%) patients (all P < .05). In multivariable CRMs, upstaging (HR: 3.8), upgrading (HR: 3.5) as well as both upstaging and upgrading (HR: 8.3), independently increased CSM. Specific upstaging to ≥pT3b/pN1-only, upgrading to ISUP ≥4-only, and both upgrading and upstaging independently increased CSM by 3.5-, 6.7-, and 26-fold, respectively.
CONCLUSION: Of all FIR RP patients, the vast majority is neither upstaged nor upgraded. Those with ≥pT3b/pN1 upstaging, ISUP ≥4 upgrading, or both are at high, higher, and extremely elevated risk of CSM, respectively, and thus require special considerations.
METHODS: Within the SEER database (2010-2021), upstaging (≥pT3a or pN1) and upgrading (ISUP ≥3) rates in FIR RP patients were tabulated. Kaplan-Meier (KM) plots and multivariable Cox-regression models (CRMs) were fitted.
RESULTS: In 9,037 FIR RP PCa patients, 1,136 (12.6%) exhibited upstaging, 1,341 (14.8%) upgrading, and 377 (4.2%) both vs. 6,937 (76.8%) that did not. Of all upstaged patients, 812 (71.5%) harbored pT3a vs. 324 (28.5%) ≥pT3b/pN1 stage. Of all upgraded patients, 1,077 (80.3%) harbored ISUP 3 vs. 264 (19.7%) ISUP ≥4. Of all upstaged and upgraded patients, 46 (12.2%) exhibited both ≥pT3b/pN1 and ISUP ≥4. Ten-year CSM-free rates in upstaged (96.0%), upgraded (95.9%) and combined upstaged and upgraded (91.0%) patients were significantly lower (P < .001) than others (98.9%). Significantly lower 10-year CSM-free rates were recorded in ≥pT3b/pN1-only (91.9%), ISUP ≥4-only (94.6%), and combined ≥pT3b/pN1 and ISUP ≥4 (85.3%) patients (all P < .05). In multivariable CRMs, upstaging (HR: 3.8), upgrading (HR: 3.5) as well as both upstaging and upgrading (HR: 8.3), independently increased CSM. Specific upstaging to ≥pT3b/pN1-only, upgrading to ISUP ≥4-only, and both upgrading and upstaging independently increased CSM by 3.5-, 6.7-, and 26-fold, respectively.
CONCLUSION: Of all FIR RP patients, the vast majority is neither upstaged nor upgraded. Those with ≥pT3b/pN1 upstaging, ISUP ≥4 upgrading, or both are at high, higher, and extremely elevated risk of CSM, respectively, and thus require special considerations.