Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press46910.17650/1726-9776-2015-11-4-59-64DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. PROSTATE CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак предстательной железыDevising and external validation of a prognostic classification of metastatic involvement risk to pelvic lymph nodes in patients with newly diagnosed prostate cancerРазработка и внешняя валидизация прогностической классификации риска метастатического поражения тазовых лимфатических узлов у пациентов с впервые выявленным раком предстательной железыLeusikE. A.ЛеусикЕ. А.
Belarus
DemeshkoP. D.ДемешкоП. Д.
Belarus
pdemeshko@me.comKrasnyS. A.КрасныйС. А.
Belarus
sergeykrasny@tut.byN. N. Aleksandrov National Cancer Centre of BelarusРеспубликанский научно-практический центр онкологии и медицинской радиологии им. Н. Н. АлександроваLesnoy Agrotown, Minsk District, Minsk Region, 223040, Republic of BelarusРеспублика Беларусь, 223040, Минская область, Минский район, агрогородок Лесной3012201511459642007201520102015https://oncourology.abvpress.ru/oncur/article/view/469

Objective – assessing the predictive significance of clinical, histologic and biochemical factors for prediction of metastases in pelvic lymph nodes (MPLN), devising and validating of prognostic classification.

Materials and methods. The study enrolled 1140 patients subjected to radical prostatectomy (RPE) with standard pelvic lymphadenectomy for prostate adenocarcinoma: 865 of them at the classification devising stage and 275 in the course of validation.

Results. According to the findings of multivariate logistic regression analysis, PSA level, the tumor cT stage and Gleason score are independent predictors of MPLN detection after RPE (p < 0.05). The prognostic factors were stratified by score for assessing the detection of regional metastases after RPE, depending on the combination of predictors. In the group of patients with a score estimate of prognostic factors < 10, the MPLN detection rate was significantly lower than in the group of with a score estimate > 15, accounting for 3.5 % and 23.7 % respectively (р < 0.0001). In the course of validating the obtained findings in clinic, metastatic involvement of pelvic lymph nodes found in the result of RPE was diagnosed in 40.0 % of the patients with a score estimate > 15 and only in 1.3 % of those with a total estimate of prognostic factors < 10 (р < 0.0001).

Цель исследования – оценить диагностическую значимость клинических, гистологических и биохимических факторов в предсказании наличия метастазов в тазовых лимфатических узлах (МТЛУ) у пациентов с впервые выявленным раком предстательной железы с последующей разработкой и валидизацией прогностической классификации.

Материалы и методы. В исследование включено 1140 пациентов, перенесших радикальную простатэктомию (РПЭ) со стандартной тазовой лимфаденэктомией по поводу аденокарциномы предстательной железы: 865 на этапе разработки классификации и 275 при ее валидизации.

Результаты. По данным мультивариантного регрессионного логистического анализа уровень простатспецифического антигена, критерий сТ опухоли и сумма баллов по шкале Глисона явились независимыми предикторами выявления МТЛУ после РПЭ (p < 0,05). Указанные прогностические факторы были стратифицированы по баллам для проведения анализа выявления регионарных метастазов после РПЭ в зависимости от сочетания предикторов. В группе пациентов с оценкой факторов прогноза < 10 баллов частота выявления МТЛУ была существенно ниже, чем в группе с оценкой >15 баллов, и составила 3,5 и 23,7 % соответственно (р < 0,0001). При валидизации полученных результатов по результатам РПЭ МТЛУ диагностировано у 40,0 % пациентов, набравших > 15 баллов, и только у 1,3 % мужчин с суммарной оценкой факторов прогноза < 10 баллов (р < 0,0001).

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