Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press36210.17650/1726-9776-2012-8-4-58-64PROSTATE CANCERРАК ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫPROGNOSTIC FACTORS OF BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY FOR LOCALIZED AND LOCALLY-ADVANCED PROSTATE CANCERФАКТОРЫ ПРОГНОЗА БИОХИМИЧЕСКОГО РЕЦИДИВА ЛОКАЛИЗОВАННОГО И МЕСТНО-РАСПРОСТРАНЕННОГО РАКА ПРОСТАТЫ ПОСЛЕ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИChernyaevV. A.ЧерняевВ. А.
Russian Federation

Department of oncology

Кафедра онкологии

chercrc@gmail.comMatveevV. B.МатвеевВ. Б.
Russian Federation

department of urology

отделение урологии

chercrc@gmail.comVolkovaM. I.ВолковаМ. И.
Russian Federation

department of urology

отделение урологии

chercrc@gmail.comNikiforovaZ. N.НикифороваЗ. Н.
Russian Federation

лаборатория онкопротеомики отделения профилактики и эпидемиологии опухолей НИИ канцерогенеза

chercrc@gmail.comShevchenkoV. E.ШевченкоВ. Е.
Russian Federation

лаборатория онкопротеомики отделения профилактики и эпидемиологии опухолей НИИ канцерогенеза

chercrc@gmail.comFPDO MGMSUФПДО МГМСУN.N. Blokhin Cancer research centerФГБУ «РОНЦ им. Н.Н. Блохина» РАМНOncoproteomics laboratory research institute of Cancerogenesis N.N. Blokhin Cancer research center, MoscowФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, Москва301220128458640808201408082014https://oncourology.abvpress.ru/oncur/article/view/362

Purpose. To reveal prognostic factors of PSA-failure following radical prostatectomy in patients with localized and locally-advanced prostate cancer.

Materials and methods. Medical data of 386 consecutive patients with localized and locally-advanced prostate cancer who underwent radical prostatectomy from 1997 to 2011 were analyzed. Median age was 61.0 years. Median PSA before surgery – 10.3 ng/ml. Plasma levels of VEGF, VEGFR2, VEGFR3, TGF-β1, CD105, IL-6 were measured using Enzyme Linked-Immuno-Sorbent Assay (ELISA) before radical prostatectomy in 77 patients. Postoperatively the tumours were categorized as pT2 in 288 (59.1 %), pT3 – in 144 (37.3 %), pT4 – in 14 (3.6); pN+ – in 34 (8.8 %) cases. Gleason score < 7 was present in 254 (65.8 %), 7 – in 132 (34.2 %) specimens. Perineural invasion was identified in 188 (48.7 %), angiolymphatic invasion – in 126 (32.6) cases.

Results. Biochemical recurrence occurred in 64 (16.6 %) out of 386 patients at a median follow-up of 30.5 (12−164) months. Independent predictors of biochemical recurrence were PSA (HR 0.161 (95% CI:0.058−0.449); р = 0.001), Gleason sum in surgical specimens (HR 0.496 (95 % CI:0.268−0.917); p = 0.025), pN (HR 0.415 (95 % CI:0.181−0.955); p = 0.039). The patients were divided into 3 prognostic groups: good (0 factor), intermediate (1 factor), poor (2 factors) and very poor (3 factors) (AUC – 0.720 (95% CI: 0.656−0.784)). High preoperative levels VEGF (67 pg/ml) (р = 0.005), VEGFR2 (3149 pg/ml) (р = 0.036), VEGFR3 (2268 pg/ml) (р = 0.001), TGF-β1 (14473 pg/ml) (р = 0.052) were identified as unfavorable prognostic factors for survival without PSA-failure.

Conclusion. Independent prognostic factors of biochemical recurrence after prostatectomy were PSA, Gleason sum and pN. Joint effect of the factors allows to predict PSA-relapse with accuracy 0.720. Preoperative serum levels VEGF, VEGFR2, VEGFR3, TGF-β1 potentially are perspective markers for PSA-failure after surgical treatment prostate cancer, further trials are needed.

Цель исследования: выявить факторы прогноза биохимического рецидива у больных раком предстательной железы, подвергнутых радикальной простатэктомии.

Материалы и методы. Проанализированы результаты лечения 386 больных раком предстательной железы Т2-4N0-1M0, подвергнутых радикальной простатэктомии (РПЭ) в РОНЦ им. Н.Н. Блохина РАМН, в период с 1997 по 2011 г. Медиана возраста – 61,0 года. Медиана концентрации простатспецифического антигена (ПСА) до лечения – 10,3 нг/мл. У 77 больных проводилась количественная оценка плазменного содержания VEGF, VEGFR2, VEGFR3, TGF-β1, CD105, IL-6 методом ELISA до операции. Всем больным выполнена РПЭ. Категория рТ расценена как рТ2 у 228 (59,1 %), рТ3 – у 144 (37,3 %), рТ4 – у 14 (3,6 %) больных; категория рN+ диагностирована в 34 (8,8 %) случаях. Сумма баллов по шкале Глисона (индекс Глисона) < 7 выявлена у 254 (65,8 %), 7 – у 132 (34,2 %) пациентов. Периневральная инвазия имела место в 188 (48,7 %), ангиолимфатическая – в 126 (32,6 %) случаях. Медиана наблюдения – 30,5 (12−164) мес.

Результаты. Рецидивы зарегистрированы у 64 (16,6 %) из 386 больных в среднем через 17,6 мес после операции. В многофакторном анализе выявлена независимая прогностическая значимость уровня ПСА (отношение рисков (ОР) 0,161 (95 % ДИ 0,058−0,449); р = 0,001), операционного индекса Глисона (ОР 0,496 (95 % ДИ 0,268−0,917); p = 0,025) и категории рN (ОР 0,415 (95 % ДИ 0,181−0,955); p = 0,039). В зависимости от числа независимых факторов риска развития ПСА-рецидива пациенты разделены на группы хорошего (0 факторов), промежуточного (1 фактор), плохого (2 фактора) и очень плохого (3 фактора) прогноза. Предсказательная точность модели – 0,720 (95 % ДИ 0,656−0,784). Высокие дооперационные плазменные концентрации VEGF (67 пкг/мл) (р = 0,005), VEGFR2 (3149 пкг/мл) (р = 0,036), VEGFR3 (2268 пкг/мл) (р = 0,001), TGF-β1 (14473 пкг/мл) (р = 0,052) являлись факторами неблагоприятного прогноза выживаемости без ПСА-рецидива.

Заключение. Независимыми факторами риска ПСА-рецидива после радикальной простатэктомии являются ПСА, операционный индекс Глисона и категория pN. Сочетанное использование данных признаков позволяет прогнозировать биохимическое прогрессирование с точностью 0,720. Предоперационные концентрации VEGF, VEGFR2, VEGFR3, TGF-β1 в плазме крови потенциально являются перспективными маркерами биохимического рецидива РПЖ после хирургического лечения и нуждаются в дальнейшем изучении. 

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