The 2002 AJCC pT2 Substages Confer No Prognostic Information on the Rate of Biochemical Recurrence After Radical Prostatectomy

• Published in: European urology 2006-02, Vol.49 (2), p.273-279
• Main Authors: Chun, Felix K.-H., Briganti, Alberto, Lebeau, Thierry, Fradet, Vincent, Steuber, Thomas, Walz, Jochen, Schlomm, Thorsten, Eichelberg, Christian, Haese, Alexander, Erbersdobler, Andreas, McCormack, Michael, Perrotte, Paul, Graefen, Markus, Huland, Hartwig, Karakiewicz, Pierre I.
• Format: Article
• Language: English
• Subjects: Analysis of Variance; Biochemical recurrence; Biological and medical sciences; Biomarkers, Tumor - blood; Confounding Factors (Epidemiology); Disease Progression; Europe - epidemiology; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Nephrology. Urinary tract diseases; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prostate cancer; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - immunology; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Radical prostatectomy; Staging; Time Factors; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2005.12.009

We examined the prognostic value of AJCC pT2 substages in prediction of biochemical recurrence (BCR) after radical prostatectomy (RP), in European patients. A cohort of 1726 RP patients with pT2N0 prostate cancer (PCa) was studied. Multivariate Cox regression models addressed the association between either the 1997 or 1992/2002 pT2 substages after controlling for total PSA, primary and secondary pathologic Gleason scores and surgical margin status and time to PSA recurrence (PSA >0.1 and rising) after RP. Regression coefficients were then used to test the predictive accuracy of multivariate models in a nomogram setting. PSA recurrence occurred in 80 (4.6%) patients. Mean and median times to recurrence were respectively 28.9 and 24.4 months. In univariate analyses, neither the 1997 (p=0.48) nor the 1992/2002 pT2 substages (p=0.054) were predictive of recurrence. In multivariate analyses the lack of significance persisted (1997 p=0.709; 1992/2002 p=0.124). When either the 1997 or 1992/2002 pT2 substages were added to a multivariate nomogram without pT2 substage information, its accuracy respectively decreased by 0.8% and 1.1%. Our data indicate that pT2 substages offer no incremental value relative to pre-treatment total PSA, surgical margin status and pathologic Gleason scores. Therefore, it might be postulated that it is sufficient to confirm organ confinement according to Partin’s pathologic staging.