Objectives: To assess the prognostic impact and predictors of adverse tumor grade in very favorable low- and intermediate-risk prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). Methods: Data of low- and intermediate PCa risk-class patients were retrieved from a prospectively maintained institutional database. Adverse tumor grade was defined as pathology ISUP grade group > 2. Disease progression was defined as a biochemical recurrence event and/or local recurrence and/or distant metastases. Associations were assessed by Cox’s proportional hazards and logistic regression model. Results: Between January 2013 and October 2020, the study evaluated a population of 289 patients, including 178 low-risk cases (61.1%) and 111 intermediate-risk subjects (38.4%); unfavorable tumor grade was detected in 82 cases (28.4%). PCa progression, which occurred in 29 patients (10%), was independently predicted by adverse tumor grade and biopsy ISUP grade group 2, with the former showing stronger associations (hazard ratio, HR = 4.478; 95% CI: 1.840–10.895;p= 0.001) than the latter (HR = 2.336; 95% CI: 1.057–5.164;p= 0.036). Older age and biopsy ISUP grade group 2 were independent clinical predictors of adverse tumor grade, associated with larger tumors that eventually presented non-organ-confined disease. Conclusions: In a very favorable PCa patient population, adverse tumor grade was an unfavorable prognostic factor for disease progression. Active surveillance in very favorable intermediate-risk patients is still a hazard, so molecular and genetic testing of biopsy specimens is needed.
目的：评估接受机器人辅助根治性前列腺切除术（RARP）治疗的极低危和中危前列腺癌（PCa）患者中不良肿瘤分级的预后影响及其预测因素。方法：从前瞻性维护的机构数据库中提取低危和中危PCa患者数据。不良肿瘤分级定义为病理ISUP分级组>2。疾病进展定义为生化复发事件和/或局部复发和/或远处转移。采用Cox比例风险模型和逻辑回归模型评估相关因素。结果：2013年1月至2020年10月期间，研究共纳入289例患者，包括178例低危病例（61.1%）和111例中危病例（38.4%）；其中82例（28.4%）检测到不良肿瘤分级。29例患者（10%）出现PCa进展，不良肿瘤分级和活检ISUP分级组2可独立预测疾病进展，前者（风险比HR=4.478；95%置信区间CI：1.840–10.895；p=0.001）较后者（HR=2.336；95% CI：1.057–5.164；p=0.036）关联性更强。高龄和活检ISUP分级组2是不良肿瘤分级的独立临床预测因素，与肿瘤体积更大且最终表现为非器官局限性疾病相关。结论：在预后极佳的PCa患者群体中，不良肿瘤分级是疾病进展的不利预后因素。对极低危中危患者进行主动监测仍存在风险，因此需要对活检标本进行分子和基因检测。
肿瘤(癌症)患者之家