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[PMID]: | 28464446 |
[Au] Autor: | Zumsteg ZS; Zelefsky MJ; Woo KM; Spratt DE; Kollmeier MA; McBride S; Pei X; Sandler HM; Zhang Z |
[Ad] Endereço: | Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. |
[Ti] Título: | Unification of favourable intermediate-, unfavourable intermediate-, and very high-risk stratification criteria for prostate cancer. |
[So] Source: | BJU Int;120(5B):E87-E95, 2017 11. | [Is] ISSN: | 1464-410X |
[Cp] País de publicação: | England |
[La] Idioma: | eng |
[Ab] Resumo: | OBJECTIVE: To improve on the existing risk-stratification systems for prostate cancer. PATIENTS AND METHODS: This was a retrospective investigation including 2 248 patients undergoing dose-escalated external beam radiotherapy (EBRT) at a single institution. We separated National Comprehensive Cancer Network (NCCN) intermediate-risk prostate cancer into 'favourable' and 'unfavourable' groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), and number of NCCN intermediate-risk factors. Similarly, NCCN high-risk prostate cancer was stratified into 'standard' and 'very high-risk' groups based on primary Gleason pattern, PPBC, number of NCCN high-risk factors, and stage T3b-T4 disease. Patients with unfavourable-intermediate-risk (UIR) prostate cancer had significantly inferior prostate-specific antigen relapse-free survival (PSA-RFS, P < 0.001), distant metastasis-free survival (DMFS, P < 0.001), prostate cancer-specific mortality (PCSM, P < 0.001), and overall survival (OS, P < 0.001) compared with patients with favourable-intermediate-risk (FIR) prostate cancer. Similarly, patients with very high-risk (VHR) prostate cancer had significantly worse PSA-RFS (P < 0.001), DMFS (P < 0.001), and PCSM (P = 0.001) compared with patients with standard high-risk (SHR) prostate cancer. Moreover, patients with FIR and low-risk prostate cancer had similar outcomes, as did patients with UIR and SHR prostate cancer. RESULTS: Consequently, we propose the following risk-stratification system: Group 1, low risk and FIR; Group 2, UIR and SHR; and Group 3, VHR. These groups have markedly different outcomes, with 8-year distant metastasis rates of 3%, 9%, and 29% (P < 0.001) for Groups 1, 2, and 3, respectively, and 8-year PCSM of 1%, 4%, and 13% (P < 0.001) after EBRT. This modified stratification system was significantly more accurate than the three-tiered NCCN system currently in clinical use for all outcomes. CONCLUSION: Modifying the NCCN risk-stratification system to group FIR with low-risk patients and UIR with SHR patients, results in modestly improved prediction of outcomes, potentially allowing better personalisation of therapeutic recommendations. |
[Mh] Termos MeSH primário: |
Gradação de Tumores Neoplasias da Próstata/patologia
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[Mh] Termos MeSH secundário: |
Idoso Seres Humanos Masculino Meia-Idade Recidiva Local de Neoplasia/mortalidade Recidiva Local de Neoplasia/patologia Estadiamento de Neoplasias Guias de Prática Clínica como Assunto Prognóstico Próstata/patologia Antígeno Prostático Específico/sangue Prostatectomia Neoplasias da Próstata/sangue Neoplasias da Próstata/mortalidade Estudos Retrospectivos Medição de Risco
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[Pt] Tipo de publicação: | JOURNAL ARTICLE |
[Nm] Nome de substância:
| EC 3.4.21.77 (Prostate-Specific Antigen) |
[Em] Mês de entrada: | 1802 |
[Cu] Atualização por classe: | 180305 |
[Lr] Data última revisão:
| 180305 |
[Sb] Subgrupo de revista: | IM |
[Da] Data de entrada para processamento: | 170503 |
[St] Status: | MEDLINE |
[do] DOI: | 10.1111/bju.13903 |
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