Feasibility of robot-assisted radical prostatectomy for very-high risk prostate cancer: surgical and oncological outcomes in men aged ≥70 years
Identifieur interne : 006C22 ( Ncbi/Merge ); précédent : 006C21; suivant : 006C23Feasibility of robot-assisted radical prostatectomy for very-high risk prostate cancer: surgical and oncological outcomes in men aged ≥70 years
Auteurs : Kyo Chul Koo ; Dae Chul Jung ; Seung Hwan Lee ; Young Deuk Choi ; Byung Ha Chung ; Sung Joon Hong ; Koon Ho RhaSource :
- Prostate International [ 2287-8882 ] ; 2014.
Abstract
Robot-assisted radical prostatectomy with pelvic lymph node dissection (RALP-PLND) is a feasible treatment option for high-risk prostate cancer (HPCa), but remains controversial for very high-risk prostate cancer (VHPCa). We aimed to assess the feasibility of RALP-PLND in men ≥70 years with VHPCa features by comparing outcomes to those of HPCa.
Among patients aged ≥70 years who underwent RALP-PLND between 2005 and 2012, 101 HPCa patients (31%) (PSA≥20 ng/mL or biopsy Gleason 8–10 or cT3a) and 53 VHPCa patients (16%) (≥cT3b or cN1) were identified. Perioperative, functional, and oncological outcomes were compared between groups.
Perioperative outcomes including operative time (
RALP-PLND is a feasible option for VHPCa in elderly patients with satisfactory oncologic outcomes; however, functional outcomes were not as favorable. Patients who are unable to accept the risk of adjuvant therapy and its side effects or incontinence should be deterred from surgical treatment, and other options such as radiation therapy could be an alternative.
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DOI: 10.12954/PI.14050
PubMed: 25325024
PubMed Central: 4186956
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Feasibility of robot-assisted radical prostatectomy for very-high risk prostate cancer: surgical and oncological outcomes in men aged ≥70 years</title><author><name sortKey="Koo, Kyo Chul" sort="Koo, Kyo Chul" uniqKey="Koo K" first="Kyo Chul" last="Koo">Kyo Chul Koo</name></author><author><name sortKey="Jung, Dae Chul" sort="Jung, Dae Chul" uniqKey="Jung D" first="Dae Chul" last="Jung">Dae Chul Jung</name></author><author><name sortKey="Lee, Seung Hwan" sort="Lee, Seung Hwan" uniqKey="Lee S" first="Seung Hwan" last="Lee">Seung Hwan Lee</name></author><author><name sortKey="Choi, Young Deuk" sort="Choi, Young Deuk" uniqKey="Choi Y" first="Young Deuk" last="Choi">Young Deuk Choi</name></author><author><name sortKey="Chung, Byung Ha" sort="Chung, Byung Ha" uniqKey="Chung B" first="Byung Ha" last="Chung">Byung Ha Chung</name></author><author><name sortKey="Hong, Sung Joon" sort="Hong, Sung Joon" uniqKey="Hong S" first="Sung Joon" last="Hong">Sung Joon Hong</name></author><author><name sortKey="Rha, Koon Ho" sort="Rha, Koon Ho" uniqKey="Rha K" first="Koon Ho" last="Rha">Koon Ho Rha</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25325024</idno><idno type="pmc">4186956</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4186956</idno><idno type="RBID">PMC:4186956</idno><idno type="doi">10.12954/PI.14050</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">004588</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004588</idno><idno type="wicri:Area/Pmc/Curation">004587</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004587</idno><idno type="wicri:Area/Pmc/Checkpoint">001B59</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001B59</idno><idno type="wicri:Area/Ncbi/Merge">006C22</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Feasibility of robot-assisted radical prostatectomy for very-high risk prostate cancer: surgical and oncological outcomes in men aged ≥70 years</title><author><name sortKey="Koo, Kyo Chul" sort="Koo, Kyo Chul" uniqKey="Koo K" first="Kyo Chul" last="Koo">Kyo Chul Koo</name></author><author><name sortKey="Jung, Dae Chul" sort="Jung, Dae Chul" uniqKey="Jung D" first="Dae Chul" last="Jung">Dae Chul Jung</name></author><author><name sortKey="Lee, Seung Hwan" sort="Lee, Seung Hwan" uniqKey="Lee S" first="Seung Hwan" last="Lee">Seung Hwan Lee</name></author><author><name sortKey="Choi, Young Deuk" sort="Choi, Young Deuk" uniqKey="Choi Y" first="Young Deuk" last="Choi">Young Deuk Choi</name></author><author><name sortKey="Chung, Byung Ha" sort="Chung, Byung Ha" uniqKey="Chung B" first="Byung Ha" last="Chung">Byung Ha Chung</name></author><author><name sortKey="Hong, Sung Joon" sort="Hong, Sung Joon" uniqKey="Hong S" first="Sung Joon" last="Hong">Sung Joon Hong</name></author><author><name sortKey="Rha, Koon Ho" sort="Rha, Koon Ho" uniqKey="Rha K" first="Koon Ho" last="Rha">Koon Ho Rha</name></author></analytic><series><title level="j">Prostate International</title><idno type="ISSN">2287-8882</idno><idno type="eISSN">2287-903X</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>Robot-assisted radical prostatectomy with pelvic lymph node dissection (RALP-PLND) is a feasible treatment option for high-risk prostate cancer (HPCa), but remains controversial for very high-risk prostate cancer (VHPCa). We aimed to assess the feasibility of RALP-PLND in men ≥70 years with VHPCa features by comparing outcomes to those of HPCa.</p></sec><sec><title>Methods</title><p>Among patients aged ≥70 years who underwent RALP-PLND between 2005 and 2012, 101 HPCa patients (31%) (PSA≥20 ng/mL or biopsy Gleason 8–10 or cT3a) and 53 VHPCa patients (16%) (≥cT3b or cN1) were identified. Perioperative, functional, and oncological outcomes were compared between groups.</p></sec><sec><title>Results</title><p>Perioperative outcomes including operative time (<italic>P</italic>=0.917), estimated blood loss (<italic>P</italic>=0.181), and complications (<italic>P</italic>=0.239) were comparable. Due to Gleason score downgrading, 19% of HPCa and 4% of VHPCa were actually of intermediate risk. VHPCa revealed higher LN involvements (<italic>P</italic>=0.002). Discrepancy between clinical and pathological nodal status was more frequent in VHPCa (36% vs. 7%, <italic>P</italic><0.01). Nodal metastasis would have been missed in 23% patients without PLND, while 13% of cN1 patients were shown to be metastasis-free by PLND. Continence rates were lower for VHPCa (32% vs. 56%, <italic>P</italic>=0.013). Although biochemical recurrence-free survival rates were comparable (<italic>P</italic>=0.648), risk for later adjuvant treatments was higher for VHPCa patients (14% vs. 34%, <italic>P</italic><0.01).</p></sec><sec><title>Conclusions</title><p>RALP-PLND is a feasible option for VHPCa in elderly patients with satisfactory oncologic outcomes; however, functional outcomes were not as favorable. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Prostate Int</journal-id><journal-id journal-id-type="iso-abbrev">Prostate Int</journal-id><journal-id journal-id-type="publisher-id">Prostate International</journal-id><journal-title-group><journal-title>Prostate International</journal-title></journal-title-group><issn pub-type="ppub">2287-8882</issn><issn pub-type="epub">2287-903X</issn><publisher><publisher-name>Asian Pacific Prostate Society (APPS)</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25325024</article-id><article-id pub-id-type="pmc">4186956</article-id><article-id pub-id-type="doi">10.12954/PI.14050</article-id><article-id pub-id-type="publisher-id">pi-2-3-127</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Feasibility of robot-assisted radical prostatectomy for very-high risk prostate cancer: surgical and oncological outcomes in men aged ≥70 years</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Koo</surname><given-names>Kyo Chul</given-names></name></contrib><contrib contrib-type="author"><name><surname>Jung</surname><given-names>Dae Chul</given-names></name><xref ref-type="author-notes" rid="fn1-pi-2-3-127"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Seung Hwan</given-names></name></contrib><contrib contrib-type="author"><name><surname>Choi</surname><given-names>Young Deuk</given-names></name></contrib><contrib contrib-type="author"><name><surname>Chung</surname><given-names>Byung Ha</given-names></name></contrib><contrib contrib-type="author"><name><surname>Hong</surname><given-names>Sung Joon</given-names></name></contrib><contrib contrib-type="author"><name><surname>Rha</surname><given-names>Koon Ho</given-names></name><xref ref-type="corresp" rid="c1-pi-2-3-127"></xref></contrib><aff id="af1-pi-2-3-127">Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul,<country>Korea</country></aff></contrib-group><author-notes><corresp id="c1-pi-2-3-127">Corresponding author: Koon Ho Rha, Department of Urology, Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea, E-mail: <email>khrha@yuhs.ac</email> / Tel: +82-2-2228-2310 / Fax: +82-2-312-2538</corresp><fn id="fn1-pi-2-3-127"><label>1</label><p>Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea</p></fn></author-notes><pub-date pub-type="ppub"><month>9</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>21</day><month>5</month><year>2014</year></pub-date><volume>2</volume><issue>3</issue><fpage>127</fpage><lpage>132</lpage><history><date date-type="received"><day>15</day><month>4</month><year>2014</year></date><date date-type="accepted"><day>21</day><month>5</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2014 Asian Pacific Prostate Society (APPS)</copyright-statement><copyright-year>2014</copyright-year><license><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Purpose</title><p>Robot-assisted radical prostatectomy with pelvic lymph node dissection (RALP-PLND) is a feasible treatment option for high-risk prostate cancer (HPCa), but remains controversial for very high-risk prostate cancer (VHPCa). We aimed to assess the feasibility of RALP-PLND in men ≥70 years with VHPCa features by comparing outcomes to those of HPCa.</p></sec><sec><title>Methods</title><p>Among patients aged ≥70 years who underwent RALP-PLND between 2005 and 2012, 101 HPCa patients (31%) (PSA≥20 ng/mL or biopsy Gleason 8–10 or cT3a) and 53 VHPCa patients (16%) (≥cT3b or cN1) were identified. Perioperative, functional, and oncological outcomes were compared between groups.</p></sec><sec><title>Results</title><p>Perioperative outcomes including operative time (<italic>P</italic>=0.917), estimated blood loss (<italic>P</italic>=0.181), and complications (<italic>P</italic>=0.239) were comparable. Due to Gleason score downgrading, 19% of HPCa and 4% of VHPCa were actually of intermediate risk. VHPCa revealed higher LN involvements (<italic>P</italic>=0.002). Discrepancy between clinical and pathological nodal status was more frequent in VHPCa (36% vs. 7%, <italic>P</italic><0.01). Nodal metastasis would have been missed in 23% patients without PLND, while 13% of cN1 patients were shown to be metastasis-free by PLND. Continence rates were lower for VHPCa (32% vs. 56%, <italic>P</italic>=0.013). Although biochemical recurrence-free survival rates were comparable (<italic>P</italic>=0.648), risk for later adjuvant treatments was higher for VHPCa patients (14% vs. 34%, <italic>P</italic><0.01).</p></sec><sec><title>Conclusions</title><p>RALP-PLND is a feasible option for VHPCa in elderly patients with satisfactory oncologic outcomes; however, functional outcomes were not as favorable. Patients who are unable to accept the risk of adjuvant therapy and its side effects or incontinence should be deterred from surgical treatment, and other options such as radiation therapy could be an alternative.</p></sec></abstract><kwd-group><kwd>Aged</kwd><kwd>Prostate neoplasms</kwd><kwd>Robotics</kwd><kwd>Treatment outcome</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-pi-2-3-127" orientation="portrait" position="float"><label>Fig. 1.</label><caption><p>Kaplan-Meier curves for biochemical recurrence (BCR)-free survival of patients with high risk and very-high risk prostate cancer. HPCa, high-risk prostate cancer; VHPCa, very high-risk prostate cancer.</p></caption><graphic xlink:href="pi-2-3-127f1"></graphic></fig><table-wrap id="t1-pi-2-3-127" orientation="portrait" position="float"><label>Table 1.</label><caption><p>Perioperative characteristics</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Characteristic</th><th align="center" valign="top" rowspan="1" colspan="1">High-risk (n=101)</th><th align="center" valign="top" rowspan="1" colspan="1">Very high-risk (n=53)</th><th align="center" valign="top" rowspan="1" colspan="1"><italic>P</italic>-value</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Age (yr)</td><td align="center" valign="top" rowspan="1" colspan="1">73.2 (71–75)</td><td align="center" valign="top" rowspan="1" colspan="1">73.5 (71–75)</td><td align="center" valign="top" rowspan="1" colspan="1">0.594</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Body mass index (kg/m<sup>2</sup>)</td><td align="center" valign="top" rowspan="1" colspan="1">23.9 (22.2–25.4)</td><td align="center" valign="top" rowspan="1" colspan="1">23.6 (21.7–25.3)</td><td align="center" valign="top" rowspan="1" colspan="1">0.448</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Preoperative PSA (ng/mL)</td><td align="center" valign="top" rowspan="1" colspan="1">16.8 (6.3–21.7)</td><td align="center" valign="top" rowspan="1" colspan="1">26.3 (8.1–35.3)</td><td align="center" valign="top" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Prostate volume (gm)</td><td align="center" valign="top" rowspan="1" colspan="1">38.2 (25.4–47.1)</td><td align="center" valign="top" rowspan="1" colspan="1">38.4 (24.6–43.8)</td><td align="center" valign="top" rowspan="1" colspan="1">0.928</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">ASA category</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">0.501</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 1</td><td align="center" valign="top" rowspan="1" colspan="1">45 (60)</td><td align="center" valign="top" rowspan="1" colspan="1">25 (52)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 2</td><td align="center" valign="top" rowspan="1" colspan="1">30 (40)</td><td align="center" valign="top" rowspan="1" colspan="1">23 (48)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Neoadjuvant hormone therapy</td><td align="center" valign="top" rowspan="1" colspan="1">20 (26)</td><td align="center" valign="top" rowspan="1" colspan="1">18 (36)</td><td align="center" valign="top" rowspan="1" colspan="1">0.139</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Nerve sparing</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">0.729</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> No</td><td align="center" valign="top" rowspan="1" colspan="1">13 (19)</td><td align="center" valign="top" rowspan="1" colspan="1">6 (17)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Unilateral</td><td align="center" valign="top" rowspan="1" colspan="1">11 (17)</td><td align="center" valign="top" rowspan="1" colspan="1">4 (11)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Bilateral</td><td align="center" valign="top" rowspan="1" colspan="1">43 (64)</td><td align="center" valign="top" rowspan="1" colspan="1">25 (72)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1">Lymph node dissection</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Standard</td><td align="center" valign="top" rowspan="1" colspan="1">49 (66)</td><td align="center" valign="top" rowspan="1" colspan="1">28 (60)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Extended</td><td align="center" valign="top" rowspan="1" colspan="1">25 (33)</td><td align="center" valign="top" rowspan="1" colspan="1">19 (41)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Operative time (min)</td><td align="center" valign="top" rowspan="1" colspan="1">199.1 (168–219)</td><td align="center" valign="top" rowspan="1" colspan="1">200.1 (170–230)</td><td align="center" valign="top" rowspan="1" colspan="1">0.917</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Estimated blood loss (mL)</td><td align="center" valign="top" rowspan="1" colspan="1">284.2 (150–400)</td><td align="center" valign="top" rowspan="1" colspan="1">347.4 (200–500)</td><td align="center" valign="top" rowspan="1" colspan="1">0.181</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Complications<xref rid="tfn2-pi-2-3-127" ref-type="table-fn"><sup>a)</sup></xref></td><td align="center" valign="top" rowspan="1" colspan="1">13 (12)</td><td align="center" valign="top" rowspan="1" colspan="1">9 (15)</td><td align="center" valign="top" rowspan="1" colspan="1">0.239</td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1"> Grade I</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Lymphedema/lymphocele</td><td align="center" valign="top" rowspan="1" colspan="1">4 (4)</td><td align="center" valign="top" rowspan="1" colspan="1">2 (4)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1"> Grade II</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Transfusion</td><td align="center" valign="top" rowspan="1" colspan="1">1 (1)</td><td align="center" valign="top" rowspan="1" colspan="1">1 (2)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1"> Grade III</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Bladder neck contracture</td><td align="center" valign="top" rowspan="1" colspan="1">0 (0)</td><td align="center" valign="top" rowspan="1" colspan="1">1 (2)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Inguinal hernia</td><td align="center" valign="top" rowspan="1" colspan="1">6 (6)</td><td align="center" valign="top" rowspan="1" colspan="1">4 (8)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Rectal injury</td><td align="center" valign="top" rowspan="1" colspan="1">2 (2)</td><td align="center" valign="top" rowspan="1" colspan="1">1 (2)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn id="tfn1-pi-2-3-127"><p>Values are presented as median (interquartile range) and number (%). PSA, prostate-specific antigen; ASA, American Society of Anesthesiologists.</p></fn><fn id="tfn2-pi-2-3-127"><label>a)</label><p>Complications are categorized by the Clavien-Dindo classification.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-pi-2-3-127" orientation="portrait" position="float"><label>Table 2.</label><caption><p>Perioperative characteristics</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Characteristic</th><th align="center" valign="top" rowspan="1" colspan="1">High-risk (n=101)</th><th align="center" valign="top" rowspan="1" colspan="1">Very high-risk (n=53)</th><th align="center" valign="top" rowspan="1" colspan="1"><italic>P</italic>-value</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">% Cores positive at biopsy</td><td align="center" valign="top" rowspan="1" colspan="1">33.3 (16.7–50)</td><td align="center" valign="top" rowspan="1" colspan="1">55.8 (30–85.7)</td><td align="center" valign="top" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Biopsy Gleason sum</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">0.258</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ≤6</td><td align="center" valign="top" rowspan="1" colspan="1">20 (20)</td><td align="center" valign="top" rowspan="1" colspan="1">10 (19)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 7</td><td align="center" valign="top" rowspan="1" colspan="1">25 (25)</td><td align="center" valign="top" rowspan="1" colspan="1">11 (21)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ≥8</td><td align="center" valign="top" rowspan="1" colspan="1">55 (55)</td><td align="center" valign="top" rowspan="1" colspan="1">31 (60)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Pathologic Gleason sum</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">0.007</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ≤6</td><td align="center" valign="top" rowspan="1" colspan="1">10 (10)</td><td align="center" valign="top" rowspan="1" colspan="1">3 (6)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 7</td><td align="center" valign="top" rowspan="1" colspan="1">51 (52)</td><td align="center" valign="top" rowspan="1" colspan="1">21 (40)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ≥8</td><td align="center" valign="top" rowspan="1" colspan="1">38 (38)</td><td align="center" valign="top" rowspan="1" colspan="1">29 (54)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Upgrading</td><td align="center" valign="top" rowspan="1" colspan="1">26 (26)</td><td align="center" valign="top" rowspan="1" colspan="1">14 (26)</td><td align="center" valign="top" rowspan="1" colspan="1">0.904</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Downgrading</td><td align="center" valign="top" rowspan="1" colspan="1">33 (32)</td><td align="center" valign="top" rowspan="1" colspan="1">5 (9)</td><td align="center" valign="top" rowspan="1" colspan="1">0.001</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Positive surgical margin</td><td align="center" valign="top" rowspan="1" colspan="1">47 (47)</td><td align="center" valign="top" rowspan="1" colspan="1">43 (60)</td><td align="center" valign="top" rowspan="1" colspan="1">0.103</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Tumor volume</td><td align="center" valign="top" rowspan="1" colspan="1">4.1 (0.9–4.5)</td><td align="center" valign="top" rowspan="1" colspan="1">5.5 (1.5–8.7)</td><td align="center" valign="top" rowspan="1" colspan="1">0.239</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Seminal vesicle invasion</td><td align="center" valign="top" rowspan="1" colspan="1">7 (7)</td><td align="center" valign="top" rowspan="1" colspan="1">12 (23)</td><td align="center" valign="top" rowspan="1" colspan="1">0.005</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Lymph node involvement</td><td align="center" valign="top" rowspan="1" colspan="1">7 (7)</td><td align="center" valign="top" rowspan="1" colspan="1">13 (25)</td><td align="center" valign="top" rowspan="1" colspan="1">0.002</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Lymph node yield</td><td align="center" valign="top" rowspan="1" colspan="1">15.3 (9–21)</td><td align="center" valign="top" rowspan="1" colspan="1">15.9 (11–21)</td><td align="center" valign="top" rowspan="1" colspan="1">0.663</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Lymphovascular invasion</td><td align="center" valign="top" rowspan="1" colspan="1">11 (11)</td><td align="center" valign="top" rowspan="1" colspan="1">7 (13)</td><td align="center" valign="top" rowspan="1" colspan="1">0.656</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Perineural invasion</td><td align="center" valign="top" rowspan="1" colspan="1">65 (65)</td><td align="center" valign="top" rowspan="1" colspan="1">34 (65)</td><td align="center" valign="top" rowspan="1" colspan="1">0.962</td></tr></tbody></table><table-wrap-foot><fn id="tfn3-pi-2-3-127"><p>Values are presented as median (interquartile range) and number (%).</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-pi-2-3-127" orientation="portrait" position="float"><label>Table 3.</label><caption><p>Discrepancies between clinical and pathologic lymph nodal status</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1"></th><th align="center" valign="top" rowspan="1" colspan="1">pN0</th><th align="center" valign="top" rowspan="1" colspan="1">pN1</th></tr></thead><tbody><tr><td colspan="3" align="left" valign="top" rowspan="1">High risk</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> cN0</td><td align="center" valign="top" rowspan="1" colspan="1">94 (93)</td><td align="center" valign="top" rowspan="1" colspan="1">7 (7)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> cN1</td><td align="center" valign="top" rowspan="1" colspan="1">0 (0)</td><td align="center" valign="top" rowspan="1" colspan="1">0 (0)</td></tr><tr><td colspan="3" align="left" valign="top" rowspan="1">Very-high risk</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> cN0</td><td align="center" valign="top" rowspan="1" colspan="1">31 (58)</td><td align="center" valign="top" rowspan="1" colspan="1">12 (23)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> cN1</td><td align="center" valign="top" rowspan="1" colspan="1">7 (13)</td><td align="center" valign="top" rowspan="1" colspan="1">3 (6)</td></tr></tbody></table><table-wrap-foot><fn id="tfn4-pi-2-3-127"><p>Values are presented as number (%).</p></fn></table-wrap-foot></table-wrap><table-wrap id="t4-pi-2-3-127" orientation="portrait" position="float"><label>Table 4.</label><caption><p>Follow-up characteristics</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Characteristic</th><th align="center" valign="top" rowspan="1" colspan="1">High-risk<break></break>(n=101)</th><th align="center" valign="top" rowspan="1" colspan="1">Very high-risk<break></break>(n=53)</th><th align="center" valign="top" rowspan="1" colspan="1"><italic>P</italic>-value</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Follow-up period</td><td align="center" valign="top" rowspan="1" colspan="1">31.1 (17.9–41.9)</td><td align="center" valign="top" rowspan="1" colspan="1">36.1 (24.7–49.9)</td><td align="center" valign="top" rowspan="1" colspan="1">0.053</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Continent at 12 months</td><td align="center" valign="top" rowspan="1" colspan="1">38 (56)</td><td align="center" valign="top" rowspan="1" colspan="1">14 (32)</td><td align="center" valign="top" rowspan="1" colspan="1">0.013</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Overall BCR-free survival</td><td align="center" valign="top" rowspan="1" colspan="1">78 (77)</td><td align="center" valign="top" rowspan="1" colspan="1">31 (58)</td><td align="center" valign="top" rowspan="1" colspan="1">0.648</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Time to BCR</td><td align="center" valign="top" rowspan="1" colspan="1">13.3 (5.5–17.5)</td><td align="center" valign="top" rowspan="1" colspan="1">12.4 (2.1–24.1)</td><td align="center" valign="top" rowspan="1" colspan="1">0.803</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Adjuvant treatment</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Hormone</td><td align="center" valign="top" rowspan="1" colspan="1">11 (11)</td><td align="center" valign="top" rowspan="1" colspan="1">14 (26)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Radiation</td><td align="center" valign="top" rowspan="1" colspan="1">2 (2)</td><td align="center" valign="top" rowspan="1" colspan="1">2 (4)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Both</td><td align="center" valign="top" rowspan="1" colspan="1">2 (2)</td><td align="center" valign="top" rowspan="1" colspan="1">2 (4)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn id="tfn5-pi-2-3-127"><p>Values are presented as median (interquartile range) and number (%). BCR, biochemical recurrence.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list></list><tree><noCountry><name sortKey="Choi, Young Deuk" sort="Choi, Young Deuk" uniqKey="Choi Y" first="Young Deuk" last="Choi">Young Deuk Choi</name><name sortKey="Chung, Byung Ha" sort="Chung, Byung Ha" uniqKey="Chung B" first="Byung Ha" last="Chung">Byung Ha Chung</name><name sortKey="Hong, Sung Joon" sort="Hong, Sung Joon" uniqKey="Hong S" first="Sung Joon" last="Hong">Sung Joon Hong</name><name sortKey="Jung, Dae Chul" sort="Jung, Dae Chul" uniqKey="Jung D" first="Dae Chul" last="Jung">Dae Chul Jung</name><name sortKey="Koo, Kyo Chul" sort="Koo, Kyo Chul" uniqKey="Koo K" first="Kyo Chul" last="Koo">Kyo Chul Koo</name><name sortKey="Lee, Seung Hwan" sort="Lee, Seung Hwan" uniqKey="Lee S" first="Seung Hwan" last="Lee">Seung Hwan Lee</name><name sortKey="Rha, Koon Ho" sort="Rha, Koon Ho" uniqKey="Rha K" first="Koon Ho" last="Rha">Koon Ho Rha</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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