Onkologische Langzeitergebnisse nach radikaler Prostatektomie in einer nicht-universitären Ausbildungsklinik

Zusammenfassung

Hintergrund Die Auswertung der onkologischen Ergebnisse nach radikaler Prostatektomie (RP) ist ein wichtiger Bestandteil der Qualitätskontrolle in Prostatakrebszentren.

Fragestellung Die Evaluation der onkologischen Ergebnisse nach RP in einer nicht-universitären Ausbildungsklinik in Deutschland und Vergleich mit anderen High-Volume-Prostatakarzinomzentren.

Material und Methoden 1161 Patienten nach RP wurden eingeschlossen und in 2 Risikogruppen eingeteilt. Low-risk: organbegrenztes PCa (pT2) und prostataspezifisches Antigen (PSA)≤ 20ng/ml und Gleason-Score (GS) 6–7b und pN0. High-risk: lokal fortgeschrittenes PCa (≥pT3a) und/oder PSA > 20ng/ml und/oder GS≥ 8 und/oder pN1. Risikogruppen und klinikopathologische Merkmale wurden in Beziehung mit biochemischem rezidiv(BCR)-freiem Überleben, karzinomspezifischem Überleben (CSS) und Gesamtüberleben (OS) gebracht.

Ergebnisse 10-Jahres-BCR-freies Überleben, CSS, OS betrugen 68,4% und 47,0%, 100% und 87,4% und 89,0% und 73,9% in der Low- und High-Gruppe (p<0,05 zwischen Risikogruppen).

Bei multivariater Cox-Regressionsanalyse war GS der signifikanteste prognostische Faktor für CSS (p=0,00001) und BCR-freies Überleben (p=0,00036). pN1-Stadium war stark mit CSS assoziiert (p=0,00004). Alter war der wichtigste Faktor für OS in der High-Risk-Gruppe (p=0,0011).

Schlussfolgerung RPE könnte in ausgewählten Fällen eine kurative Therapieoption für das lokal fortgeschrittene PCa sein. GS ist der wichtigste prognostische Faktor. Gute onkologische Ergebnisse können auch in nicht-universitären Ausbildungskliniken erzielt werden.

Abstract

Background The evaluation of oncological outcomes after radical prostatectomy (RP) is a major component of quality control in prostate cancer (PCa) centres.

Objectives To evaluate the oncological outcomes after RP in a non-university teaching hospital and compare them with other high-volume PCa centres.

Material und methods This study included 1,161 patients after RP who were divided into two risk groups. Low-risk: localised PCa (pT2) and prostate-specific antigen (PSA)≤ 20 ng/ml, Gleason score (GS) 6–7b and pN0. High-risk: locally advanced PCa (≥pT3a) and/or PSA >20 ng/ml and/or GS≥ 8 and/or pN1. Risk groups and clinicopathological features were correlated to biochemical recurrence (BCR)-free survival, cancer-specific survival (CSS) und overall survival (OS).

Results The 10-year BCR-free survival, CSS und OS were 68.4%, 47.0% and 100% in the low-risk group and 87.4%, 89.0% and 73.9% in the high-risk group, respectively; the outcomes between risk groups were statistically significant (p<0.05). A multivariate Cox regression analysis was performed. GS was the most significant prognostic factor for CSS (p=0.00001) und BCR-free survival (p=0.00036). Nodal involvement (pN1) was strongly associated with CSS (p=0.00004). Age was the most important factor for overall survival in the high-risk group (p=0.0011).

Conclusions RP could be a curative treatment option for advanced PCa in selected cases. GS is the most important prognostic factor. Good oncological outcomes can also be achieved in non-university teaching hospitals.

Schlüsselwörter

Prostatakarzinom - radikale Prostatektomie - onkologische Ergebnisse - Prostatakarzinomzentrum

Keywords

prostate cancer - radical prostatectomy - oncological outcomes - prostate cancer centre

Publikationsverlauf

Eingereicht: 11. Juni 2024

Angenommen nach Revision: 27. Juli 2024

Artikel online veröffentlicht:
10. September 2024

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