Risk factors for biochemical recurrence of prostate cancer after radical prostatectomy

Jian CHEN; Qiming CHEN; Ze WANG; Haiyang XIAO; Qiang RAN; Qiuli LIU; Yaoming LI; Zehua SHU; Yao ZHANG; Jun ZHANG; Ke LI; Luofu WANG; Weihua LAN; Jun JIANG

doi:10.16016/j.2097-0927.202303007

您当前的位置：

首页 >

文章列表页 >

Risk factors for biochemical recurrence of prostate cancer after radical prostatectomy

Clinical Medicine | 更新时间：2026-01-09

- Risk factors for biochemical recurrence of prostate cancer after radical prostatectomy
- Journal of Army Medical University Vol. 45, Issue 18, Pages: 1955-1964(2023)
- 作者机构：
  
  400010 重庆，陆军特色医学中心泌尿外科
- 作者简介：
- 基金信息：
  
  the National Natural Science Foundation for Young Scholars of China(81902600);the Scientific Research Project of Army Medical University(2018XLC1014)
- DOI：10.16016/j.2097-0927.202303007
  CLC： R730.56;R730.7;R737.25
- Received：01 March 2023，
  
  Revised：2023-04-10，
  
  Published：30 September 2023
- 稿件说明：
移动端阅览
Jian CHEN, Qiming CHEN, Ze WANG, et al. Risk factors for biochemical recurrence of prostate cancer after radical prostatectomy[J]. Journal of Army Medical University, 2023, 45(18): 1955-1964.
DOI：

Jian CHEN, Qiming CHEN, Ze WANG, et al. Risk factors for biochemical recurrence of prostate cancer after radical prostatectomy[J]. Journal of Army Medical University, 2023, 45(18): 1955-1964. DOI： 10.16016/j.2097-0927.202303007.

摘要

目的

分析前列腺癌根治术(radical prostatectomy，RP)后生化复发的危险因素，并建立风险预测模型。

方法

本研究采用回顾性队列研究方法，分析2007年9月至2022年3月在本院接受前列腺癌根治术的患者279例，收集并分析临床指标共21项。纳入时间因素，应用Lasso回归筛选指标，Kaplan-Meier法绘制生存曲线，采用单因素、多因素Cox比例风险回归模型分析危险因素并建立预测模型，受试者工作特征(receiver operating characteristic curve，ROC)曲线评价模型的判别能力。并基于危险因素建立生化复发的风险预测列线图，应用校正曲线评价预测的准确性，决策曲线分析其临床效益。

结果

中位随访时间37.10(17.60，61.30)月，中位年龄68.00(65.00，72.00)岁，其中86例(30.8%)生化复发。单因素分析显示共12个指标与RP术后生化复发密切相关(

＜0.05)，并应用Lasso回归筛选得到7个具有代表性的指标集：营养风险指数(nutritional risk index，NRI)、临床T分期、病理Gleason评分、病理T分期、切缘阳性、淋巴结侵犯、精囊侵犯。再进行多因素分析显示，病理高分期(≥pT3期)(

=1.895

95%

: 1.045~3.435，

=0.035)、切缘阳性(

=1.808

95%

: 1.006~3.250，

=0.048)、淋巴结侵犯(

=2.161

95%

: 1.118~4.175，

=0.022)、NRI≤106.9(

=0.598

95%

: 0.378~0.946，

=0.028)是生化复发的独立危险因素。建立预测模型，其AUC为0.743(95%

：0.677~ 0.810，

＜0.001)，敏感度为0.826，特异度为0.534。并建立预测列线图，C-index：0.741(95%

：0.677~0.805；

＜0.001)，校正曲线表明一致性较好。临床决策曲线表明在阈值概率为15%~85%的区间可临床获益，临床效用较好。

结论

病理高分期(≥pT3期)、切缘阳性、淋巴结侵犯、NRI≤106.9是前列腺癌根治术后生化复发的独立危险因素，建立的预测模型能进行有效判断，为临床决策提供参考。

Abstract

Objective

To analyze the risk factors for biochemical recurrence in prostate cancer patients after radical prostatectomy (RP) and establish a risk prediction model for the recurrence.

Methods

A retrospective cohort study was conducted on 279 patients who underwent RP surgery in our hospital from September 2007 to March 2022. There were 21 clinical indicators collected and analyzed. After time factors were included

Lasso regression was applied to screen the indicators

Kaplan-Meier method was used to draw survival curve

univariate and multivariate Cox proportional risk regression models were employed to analyze the risk factors and establish a prediction model. Then receiver operating characteristic (ROC) curve were plotted to evaluate the discriminative performance of the model. Then a nomogram was draw based on the obtained risk factors. Calibration curve was used to evaluate the accuracy of prediction

and decision curve was employed to assess the clinical benefit.

Results

During a median follow-up time of 37.10 (17.60

61.30) months

86 cases (30.8%)

at a median age of 68.00 (65.00

72.00) years

experienced biochemical recurrence. Univariate analysis showed that 12 indicators were strongly associated with biochemical recurrence after RP (

0.05)

and Lasso regression screening indicated 7 representative indicator sets

including nutritional risk index (NRI)

clinical T-stage

pathological Gleason score

pathological T-stage

positive surgical margin

lymph node invasion

and seminal vesicle invasion. Further multifactorial analysis revealed that pathological high stage (≥pT3 stage) (

=1.895

95%

: 1.045~3.435

=0.035)

positive surgical margin (

=1.808

95%

: 1.006~3.25

=0.048)

lymph node invasion (

=2.161

95%

: 1.118~4.175

=0.022) and NRI ≤106.9 (

=0.598

95%

: 0.378~0.946

=0.028) were independent risk factors for biochemical recurrence. The predictive equation was established with an AUC of 0.743 (95%

: 0.677~0.810

0.001)

a sensitivity of 0.826 and a specificity of 0.534. And the established nomogram has a C-index of 0.741 (95%

: 0.677~0.805;

0.001)

with good agreement indicated by calibration curve. Clinical decision curve displayed that there was a net benefit when the threshold probability was 15%~85%.

Conclusion

High pathological stage (≥pT3 stage)

positive surgical margin

lymph node invasion

and NRI ≤106.9 are independent risk factors for biochemical recurrence of prostate cancer after RP. Our prediction model can make effective judgments and provide references for clinical decision making.

关键词

Keywords

references

SIEGEL R L, MILLER K D, GODING SAUER A, et al . Colorectal cancer statistics, 2020[J ] . CA Cancer J Clin, 2020, 70(3): 145-164. DOI: 10.3322/caac.21601.

NETTO G J, AMIN M B, BERNEY D M, et al . The 2022 World Health Organization classification of tumors of the urinary system and male genital organs—part B: prostate and urinary tract tumors[J ] . Eur Urol, 2022, 82(5): 469-482. DOI: 10.1016/j. eururo.2022.07.002.

MOTTET N, VAN DEN BERGH R C N, BRIERS E, et al . EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer—2020 update. part 1: screening, diagnosis, and local treatment with curative intent[J ] . Eur Urol, 2021, 79(2): 243-262. DOI: 10.1016/j.eururo.2020.09.042.

张明, 齐进春. 2019版中国泌尿外科前列腺癌诊断治疗指南更新要点解读[J]. 河北医科大学学报, 2021, 42(10): 1117-1122, 1154. DOI: 10.3969/j.issn.1007-3205.2021.10.001.

ZHANG M, QI J C. Interpretation of the update points of China Urology Prostate Cancer Diagnosis and Treatment Guidelines in 2019 Edition[J]. J Hebei Med Univ, 2021, 42(10): 1117-1122, 1154. . DOI: 10.3969/j.issn.1007-3205.2021.10.001.

VAN DEN BROECK T, VAN DEN BERGH R C N, ARFI N, et al . Prognostic value of biochemical recurrence following treatment with curative intent for prostatecancer: a systematic review[J ] . Eur Urol, 2019, 75(6): 967-987. DOI: 10.1016/j.eururo.2018.10.011.

SONG W, LEE D H, JEON H G, et al . Impact of Gleason score on biochemical recurrence in patients with pT3aN0/Nx prostate cancer with positive surgical margins: a multicenter study from the Prostate Cancer Research Committee[J ] . J Cancer Res Clin Oncol, 2017, 143(11): 2393-2400. DOI: 10.1007/s00432-017-2502-7.

范宇, 叶林·木拉提, 梁磊, 等. 根治性前列腺切除术后影响患者临床治愈和生化复发的危险因素分析[J]. 中华泌尿外科杂志, 2021, 42(9): 644-649. DOI: 10.3760/cma.j.cn112330-20210720-00379.

FAN Y, MULATI Y L, LIANG L, et al . Analysis of risk factors for clinical cure and biochemical recurrence in patients after radical prostatectomy[J ] . Chin J Urol, 2021, 42(9): 644-649. DOI: 10.3760/cma.j.cn112330-20210720-00379.

PANUNZIO A, SORCE G, HOEH B, et al . Effect of positive surgical margins at radical prostatectomy on cancer-specific mortality in high/very high-risk prostate cancer patients with Gleason Grade Group 4-5[J ] . Prostate, 2023, 83(3): 268-276. DOI: 10.1002/pros.24458.

PREISSER F, HEINZE A, S ABRAMS-POMPE R, et al . Impact of positive surgical margin length and Gleason grade at the margin on oncologic outcomes in patients with nonorgan-confined prostate cancer[J ] . Prostate, 2022, 82(9): 949-956. DOI: 10.1002/pros.24341.

REEVES F A, BATTYE S, ROTH H, et al . Prostatic nerve subtypes independently predict biochemical recurrence in prostate cancer[J ] . J Clin Neurosci, 2019, 63: 213-219. DOI: 10.1016/j.jocn.2019.01.052.

GUO Y D, WANG R L, WU P F, et al . Preoperative nutritional risk index predicts recurrence of oligometastatic prostate cancer in patients undergoing cytoreductive radical prostatectomy[J ] . Nutr Cancer, 2021, 73(8): 1440-1447. DOI:10.1080/01635581.2020.1795694.

张志昱, 周奇, 张江磊, 等. 术前白蛋白碱性磷酸酶比值对前列腺癌根治术后生化复发时间的影响[J]. 大连医科大学学报, 2021, 43(5): 413-418. DOI: 10.11724/jdmu.2021.05.06.

ZHANG Z Y, ZHOU Q, ZHANG J L, et al . Predictive value of preoperative albumin-to-alkaline phosphatase ratio on biochemical recurrence after radical prostatectomy[J ] . J Dalian Med Univ, 2021, 43(5): 413-418. DOI: 10.11724/jdmu.2021.05.06.

WANG S, YANG X, YU Z Y, et al . The values of systemic immune-inflammation index and neutrophil-lymphocyte ratio in predicting testicular germ cell tumors: a retrospective clinical study[J ] . Front Oncol, 2022, 12: 893877. DOI: 10.3389/fonc.2022.893877.

KANEHIRA M, TAKATA R, ISHⅡ S, et al . Predictive factors for short-term biochemical recurrence-free survival after robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients[J ] . Int J Clin Oncol, 2019, 24(9): 1099-1104. DOI: 10.1007/s10147-019-01445-7.

LIU X A, MENG Q H, YE Y Q, et al . Prognostic significance of pretreatment serum levels of albumin, LDH and total bilirubin in patients with non-metastatic breast cancer[J ] . Carcinogenesis, 2015, 36(2): 243-248. DOI: 10.1093/carcin/bgu247.

VAN DEN BROECK T, VAN DEN BERGH R C N, BRIERS E, et al . Biochemical recurrence in prostate cancer: the European Association of Urology Prostate Cancer Guidelines Panel Recommendations[J ] . Eur Urol Focus, 2020, 6(2): 231-234. DOI: 10.1016/j.euf.2019.06.004.

戴波, 常坤, 孔蕴毅, 等. 根治性前列腺切除术后患者生化复发的危险因素分析[J]. 中华外科杂志, 2015, 53(4): 261-265.

DAI B, CHANG K, KONG Y Y, et al . Analysis of biochemical recurrence following radical prostatectomy[J ] . Chin J of Surg, 2015, 53(4): 261-265. DOI: 10.3760/cma.j.issn.0529-5815.2015.04.006.

张云龙, 刘秉乾, 武玉东. 前列腺癌根治术后生化复发的危险因素[J]. 河南医学研究, 2020, 29(7): 1167-1169.

ZHANG Y L, LIU B Q, WU Y D. Risk factors for biochemical recurrence after radical prostatectomy[J]. Henan Med Res, 2020, 29(7): 1167-1169. DOI: 10.3969/j.issn.1004-437X.2020.07.006.

马帅军, 张景良, 苏醒, 等. 根治性前列腺切除术后生化复发的危险因素分析[J]. 中华泌尿外科杂志, 2022, 43(1): 35-39.

MA S J, ZHANG J L, SU X, et al . Risk factor analysis of patients with biochemical recurrence after radical prostatectomy[J ] . Chin J of Urol, 2022, 43(1): 35-39. DOI: 10.3760/cma.j.cn112330-20210722-00388.

JIN C, BIAN Z C, MO F, et al . Establishment and validation of coagulation factor-based nomogram for predicting the recurrence-free survival of prostate cancer[J ] . Urol Int, 2022, 106(9): 954-962. DOI: 10.1159/000519329.

COOPERBERG M R, HILTON J F, CARROLL P R. The CAPRA -S score[J ] . Cancer, 2011, 117(22): 5039-5046. DOI: 10.1002/cncr.26169.

CUZICK J, SWANSON G P, FISHER G, et al . Prognostic value of an RNA expression signature derived from cell cycle proliferation genes in patients with prostate cancer: a retrospective study[J ] . Lancet Oncol, 2011, 12(3): 245-255. DOI: 10.1016/S1470-2045(10)70295-3.

陈彦君, 刘建萍, 龚志勇. 预测前列腺癌根治术后生化复发的研究[J]. 医学信息, 2021, 34(5): 49-53. DOI: 10.3969/j.issn.1006-1959.2021.05.015.

CHEN Y J, LIU J P, GONG Z Y. Study on the prediction of biochemical recurrence after radicalprostatectomy[J]. J Med Inf, 2021, 34(5): 49-53. DOI: 10.3969/j.issn.1006-1959.2021.05.015.

高旭, 王海峰, 方梓宇, 等. 前列腺癌根治术后生化复发的危险因素: 单中心301例临床分析[J]. 中华泌尿外科杂志, 2014, 35(3): 191-194. DOI: 10.3760/cma.j.issn.1000-6702.2014.03.008.

GAO X, WANG H F, FANG Z Y, et al . Risk factors of biochemical recurrence after radical prostatectomy: clinical analysis of 301 cases in a single-center[J ] . Chin J Urol, 2014, 35(3): 191-194. DOI: 10.3760/cma.j.issn.1000-6702.2014.03.008.

BAKAVIČIUS A, DREVINSKAITĖ M, DANIŪNAITĖ K, et al . The impact of prostate cancer upgrading and upstaging on biochemical recurrence and cancer-specific survival[J ] . Medicina, 2020, 56(2): 61. DOI: 10.3390/medicina56020061.

KANG M Y, OH J J, LEE S, et al . Perineural invasion and lymphovascular invasion are associated with increased risk of biochemical recurrence in patients undergoing radical prostatectomy[J ] . Ann Surg Oncol, 2016, 23(8): 2699-2706. DOI: 10.1245/s10434-016-5153-z.

严于昊, 胡广漠, 谢超, 等. 前列腺癌生化复发危险因素报告: 单中心11年回顾分析[J]. 现代泌尿生殖肿瘤杂志, 2022, 14(3): 150-155. DOI: 10.3870/j.issn.1674-4624.2022.03.005.

YAN Y H, HU G M, XIE C, et al . Risk factors for biochemical recurrence of prostate cancer: a single-center 11-year retrospectiveanalysis[J ] . J Contemp Urol Reprod Onc ol, 2022, 14(3): 150-155. DOI: 10.3870/j.issn.1674-4624.2022.03.005.

SACHDEVA A, VEERATTERAPILLAY R, VOYSEY A, et al . Positive surgical margins and biochemical recurrence following minimally-invasive radical prostatectomy—An analysis of outcomes from a UK tertiary referralcentre[J ] . BMC Urol, 2017, 17(1): 91. DOI: 10.1186/s12894-017-0262-y.

KIR G, ARIKAN E A, SENELDIR H, et al . Determining the cut-off values of tumor diameter, degree of extraprostatic extension, and extent of surgical margin positivity with regard to biochemical recurrence of prostate cancer after radical prostatectomy[J ] . Ann Diagn Pathol, 2020, 44: 151431. DOI: 10.1016/j.anndiagpath.2019.151431.

PENG C, ZHANG J, HOU J Q. Performance characteristics of prostate-specific antigen density and biopsy primary Gleason score to predict biochemical failure in patients with intermediate prostate cancer who underwent radical prostatectomy[J]. Cancer Manag Res, 2019, 11: 1133-1139. DOI: 10.2147/cmar.s190443.

ZANATY M, AJIB K, ALNAZARI M, et al . Prognostic utility of neutrophil-to-lymphocyte and platelets-to-lymphocyte ratio in predicting biochemical recurrence post robotic prostatectomy[J ] . Biomark Med, 2018, 12(8): 841-848. DOI: 10.2217/bmm-2017-0321.

RYAN A M, POWER D G, DALY L, et al . Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later[J ] . Proc Nutr Soc, 2016, 75(2):199-211. DOI: 10.1017/s002966511500419x.

EFREMOVA M, RIEDER D, KLEPSCH V, et al . Targeting immune checkpoints potentiatesimmunoediting and changes the dynamics of tumor evolution[J ] . Nat Commun, 2018, 9(1): 1-13. DOI: 10.1038/s41467-017-02424-0.

SEJIMA T, IWAMOTO H, MASAGO T, et al . Low pre-operative levels of serum albumin predict lymph node metastases and ultimately correlate with a biochemical recurrence of prostate cancer in radical prostatectomy patients[J ] . Cent European J Urol, 2013, 66(2): 126-132. DOI: 10.5173/ceju.2013.02.art3.

CAO Y, MA J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis[J]. Cancer Prev Res (Phila), 2011, 4(4): 486-501. DOI: 10.1158/1940-6207.CAPR-10-0229.

KIM S J, PARK M U, CHAE H K, et al . Overweight and obesity as risk factors for biochemical recurrence of prostate cancer after radical prostatec tomy[J ] . Int J Clin Oncol, 2022, 27(2): 403-410. DOI: 10.1007/s10147-021-02058-9.

SIDDIQUI S A, INMAN B A, SENGUPTA S, et al . Obesity and survival after radical prostatectomy: a 10-year prospective cohortstudy[J ] . Cancer, 2006, 107(3): 521-529. DOI: 10.1002/cncr.22030.

RAMOS R, NADAL E, PEIRÓ I, et al . Preoperative nutritional status assessment predicts postoperative outcomes in patients with surgically resected non-small cell lungcancer[J ] . Eur J Surg Oncol, 2018, 44(9): 1419-1424. DOI: 10.1016/j.ejso.2018.03.026.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Incidence and risk factors of acute renal injury after Stanford type A aortic dissections

Predictive value and risk factors of embryo implantation site for placenta previa

Construction and validation of a risk prediction model for lean metabolic dysfunction-associated steatotic liver disease

Metformin delays progression of prostate cancer: a retrospective study on 192 cases

Analysis of factors affecting first serum prostate specific antigen level after radical prostatectomy for prostate cancer

Related Author

XU Xiao

LI Xiaodong

WEN Jing

NING Jiaolin

KUANG Na

HE Wenjiao

XIONG Xi

CHEN Zhengqiong

Related Institution

Department of Anesthesiology， First Affiliated Hospital， Army Medical University （Third Military Medical University）

Department of Obstetrics and Gynecology， Second Affiliated Hospital， Army Medical University （Third Military Medical University）

Department of Gastroenterology， First Affiliated Hospital， Army Medical University （Third Military Medical University）

Department of Urology, Daping Hospital, Army Medical University (Third Military Medical University)

Institute of Urology, First Affiliated Hospital, Army Medical University (Third Military Medical University)

⁰