The Impact of Clinical Stage on Prostate Cancer Survival Following Radical Prostatectomy.

Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN 55905.
The Journal of urology (Impact Factor: 3.75). 11/2012; DOI: 10.1016/j.juro.2012.11.065
Source: PubMed

ABSTRACT INTRODUCTION AND OBJECTIVE: Clinical stage has been incorporated into multiple risk stratification models for patients with newly-diagnosed prostate cancer. However, the independent prognostic value of this variable remains in debate. Here, then, we evaluated the association of clinical stage with death from prostate cancer in men undergoing radical prostatectomy, and assessed for changes in its prognostic value over time. METHODS: We reviewed 14,842 consecutive patients who underwent radical prostatectomy at our institution between 1970 and 2008 without preoperative hormone or radiation therapy. Postoperative disease recurrence was estimated using the Kaplan-Meier method and compared using the log rank test. Multivariate Cox proportional hazard regression models were used to analyze the association of clinical stage with outcome. RESULTS: In total, 5,725 (38.6%)men were classified as cT1, 8,160 (55.0%) cT2 tumors, and 957 (6.4%) cT3. On univariate analysis, clinical stage was significantly associated with postoperative biochemical recurrence, systemic progression, and death from prostate cancer (p<0.001 for each). Moreover, on multivariate analysis clinical stage was significantly associated with cancer death both for patients treated before (1.45, p=0.006) and during (1.92, p>0.001) the PSA era. Furthermore, incorporation of clinical stage into contemporary risk stratification improves prediction of cancer-specific survival (c statistic - 0.782 without and 0.802 with clinical stage). CONCLUSIONS: Clinical stage is significantly associated with systemic progression and death from prostate cancer. Inclusion of this variable into multivariate prediction models improves prediction of systemic progression and cancer specific survival.

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