pT3a Patients Research Articles

Biochemical outcomes after robot-assisted radical prostatectomy in patients with follow-up more than 5-years

In this study, we assessed biochemical outcomes after robot-assisted radical prostatectomy (RARP). Between July 2005 and November 2007, one hundred and seventy-six consecutive patients treated by RARP without neoadjuvant treatment were included in this study. All procedures were performed by a single surgeon and the median follow-up period was 60 months (interquartile range (IQR): 59-69). The median prostate specific antigen was 7.50ng ml(-1) (IQR: 5.14-11.45) and 39.2% of the patients were classified as intermediate risk and 15.3% were classified as high risk; on final pathological examination, 35.2% of the patients had non-organ confined disease and 37.5% and 14.2% had Gleason scores of 7 and 8-10, respectively. The biochemical recurrence (BCR)-free survival rates at 3 and 5 years were 85.6% and 81.2%, respectively. The 5-year BCR-free survival rates stratified by pathologic Gleason scores were 93.1% in Gleason scores of 6 or less, 74.5% in a Gleason score of 7, and 58.1% in Gleason scores of 8 or greater, respectively (P<0.001). When stratified by pathologic stage, the BCR-free survival rates were 89.8% in pT2 patients, 66.2% in pT3a patients, and 39.3% in pT3b patients at 5 years following RARP, respectively (P<0.001). Preoperative prostate-specific antigen (PSA), pathologic stage, postoperative Gleason score and surgical margin status were independently associated with BCR in multivariate analysis. In this study, we report biochemical outcomes after RARP with the longest follow-up periods to date in Asian men. We found that robotic surgery provided satisfactory biochemical outcomes, and that RARP is a safe and effective procedure in terms of oncologic outcomes.

Identification of prostate cancer risk categories according to surgical margins status, pathological stage and Gleason score

One-third of patients with positive surgical margins after radical prostatectomy develop recurrent disease. The distinction between pT2 with positive margins and pT3a can be difficult. Aim of the present study was to assess the impact of positive surgical margins on biochemical relapse after radical prostatectomy, adjusted for pathological stage and Gleason score. We retrospectively evaluated 837 consecutive patients who underwent radical prostatectomy for organ-confined or locally-advanced prostate cancer. Exclusion criteria were: presence of node or distant metastases, neo-adjuvant or adjuvant therapy, and unavailability of full data regarding pathological stage and margin status. A single dedicated genitourinary pathologist evaluated all the specimens. The Kaplan-Meier method and univariable and multivariable Cox regressions were applied for survival analyses. The median follow up was 54.0 ± 35.0 months. Margin status, prostate-specific antigen and Gleason score significantly predicted biochemical relapse in the pT2 group at multivariable analysis, whereas only pathological stage and pathological Gleason score were significant predictors of recurrence in pT3a patients. There were no significant differences in biochemical disease-free survival among pT2 with positive margins patients and pT3a patients (with or without positive surgical margins). Pathological Gleason score was the only significant predictor of biochemical relapse in patients with negative and positive margins, regardless of the pathological stage. pT2 patients with positive surgical margins and pT3a (with or without positive margins) seem to have similar biochemical disease-free survival. Positive margins and pathological stage might be insufficient clinical predictors. Gleason score remains the most reliable prognostic factor.

Significance of tumor size in renal cell cancer with perinephric fat infiltration: is TNM staging system adequate for predicting prognosis?

To evaluate the influence of perinephric fat infiltration and tumor size on survival of patients with renal cell carcinoma (RCC). We have retrospectively reviewed the records of 338 consecutive patients with pT1-3aN0M0 RCC, including 275 pT1-2 and 63 pT3a tumors, who underwent open partial or radical nephrectomy between 1995 and 2008. Univariate and multivariate analyses were performed in order to evaluate the prognostic factors. Median follow-up period was 36.07 months. Receiver Operating Characteristic curve analysis determined the optimal tumor size cutoff value as 7 cm (Area Under the Curve: 0.65 ± 0.047; 95% Confidence Interval: 0.558 to 0.741). Perinephric fat invasion and Fuhrman grade were independent prognostic factors for disease-specific survival (DSS). In patients with tumor size >7 cm, perinephric fat invasion affected DSS significantly. Tumor size (according to the cutoff value of 7 cm) significantly affected DSS in patients with pT3a disease. According to the TNM 2002 staging system, perinephric fat invasion did not have any significant effect on DSS in patients with tumor size smaller than 4 cm, unlike tumor size of 4 to 7 cm and >7 cm. pT3a tumors larger than 7 cm demonstrated the worst prognosis compared to other groups. Perinephric fat invasion was demonstrated as a significant prognostic factor for RCC patients with tumor size >4 cm. Consequently, evaluation of pT3a patients should take tumor size into consideration for better prognostic analysis.

Stage-by-Stage Effects of Surgical Margin Status on Biochemical Failure after Radical Prostatectomy in Patients with Clinically Localized Prostate Cancer

Purpose: To evaluate the effects of pathological stage and surgical margin status on biochemical failure rates after radical prostatectomy (RP). Materials and Methods: The records of 205 patients who underwent RP for clinically localized prostate cancer (CaP) were evaluated. Known risk factors for biochemical failure (BF) were analyzed using univariate and multivariate logistic regression analysis. The effects of surgical margin status together with pathological stage on BF were evaluated. p values lower than 0.05 were accepted to be statistically significant. Results: Pathological stage, positive surgical margin (PSM), seminal vesicle invasion, lymph node involvement, biopsy Gleason score and postoperative Gleason score were the factors associated with BF in univariate analysis. Logistic regression analysis revealed that pT3a patients with PSM had a significant BF rate when compared to pT2 patients with a negative surgical margin (NSM) (OR 7.46, p = 0.002). pT3a patients with a NSM had a similar BF rate to that of pT2 patients with PSM. Conclusions: pT2 patients with PSM had a similar biochemical prognosis to that of pT3a patients without PSM, implicating that a PSM may have a negative effect on prognosis similar to that of extracapsular invasion.

Comparison of the Prognosis between pT3a Only Patients with Perirenal Fat Invasion and T1/T2 Patients, Respectively: Is It Necessary to Revise Stage T3a?

Purpose: As compared with pathologic stages T1 and T2, we aimed to investigate the difference of the prognosis for the patients with perirenal fat invasion (pT3a), and the patients were divided into two groups by the tumor size of 7cm. Materials and Methods: Of the 503 patients who underwent an operation for renal cell carcinoma between June 1995 and April 2004, we retro- spectively reviewed the records of 455 patients with T1, T2 and T3a stage renal cell carcinoma without adrenal invasion. We evaluated the cell type, the multifocality of the tumor, the nuclear grade, the presence of a sar- comatoid component and the coagulative histologic necrosis. We divided the patients with pT3a renal cell carcinoma into two groups according to the tumor size of 7cm (Group 1; †7cm pT3a, Group 2; ĥ7cm pT3a). The overall survival was estimated using the Kaplan-Meier method and the log-rank test. We used Students s t-test to compare each factors between groups 1 and 2 and the T1 and T2 groups, respectively. The prognostic factors that had an influence on survival were estimated using the Cox proportional hazard regression model in each group. Results: After the exclusion criteria (the presence of adrenal invasion in pT3a patients) were applied, 24 patients were in group 1, 23 patients were in group 2, 328 patients had pT1 disease and 80 patients had pT2 disease. The median follow-up was 45.4 months. When group 1 was compared to the pT1 group, there was no significantly difference of the estimated survival (p=0.21). There was a similar result when comparing the esti- mated survival between group 2 and the pT2 group (p=0.80). Conclusions: No significant difference exists for the disease specific survival when patients with pT3a disease (Groups 1 and 2) are compared to the patients with either pT1 or pT2 disease. These findings reveal that patients with pT3a disease without adrenal invasion have similar outcomes to patients with either with pT1 or pT2 disease. Therefore, our result sug- gests that pT3a tumor should be re-classified according to tumor size into

The prognostic inhomogeneity in pT3 rectal carcinomas.

To obtain data on locoregional recurrence and survival rates in prognostically inhomogeneous pT3 rectal carcinomas we analyzed the data on 853 patients of the Erlangen Registry for Colo-Rectal Carcinomas (ERCRC) and 600 patients of the Study Group for Colo-Rectal Carcinoma (SGCRC), stage I-III, treated by radical surgery alone. The category pT3 was subdivided according to the histological measurement of the maximal tumor invasion beyond the outer border of the muscularis propria: pT3a (up to 5 mm) and pT3b (more than 5 mm). In the ERCRC locoregional recurrence rates were 10.4% (95% confidence interval 6.0-14.6) for pT3a and 26.3% (20.6-31.6) for pT3b (P<0.0001). The cancer-related 5-year survival rates were 85.4% (80.6-90.5) for pT3a and 54.1% (48.5-60.5) for pT3b (P<0.0001). Lymph node negative pT3a and pT2 patients showed very similar 5-year survival rates (91.2% vs. 93.6%, respectively) as well as lymph node positive pT3a and pT2 patients (77.8% vs. 82.8%, respectively). In the SGCRC patients similar but statistically marginal differences between pT3a and pT3b tumors were observed. An extended pT classification (pT1, pT2, pT3a, pT3b, pT4) thus allows an improved prediction of outcome in rectal carcinoma patients. The subdivision of pT3 enables the identification of stage II patients (pT3a pNO) who might not benefit from adjuvant treatment.

Cáncer de próstata estadio pt3 tras prostatectomía radical. resultados en progresión y supervivencia

PurposeTo analyse progression and survival after radical prostatectomy in patients with stage pT3 carcinoma of the prostate. Material And MethodsBetween 1986 and November 1998, we performed 372 radical prostatectomies, 74 of wich were pT3N0 (19,8%), 43 pT3a and 31 pT3b (TNM 97). ResultsIn patients with pathological stage pT3, we found any progression in 24 patients (32%), 8 in pT3a, and 16 in pT3b. In 10 of 24 pT3, there was local relapse or distant metastases. About the freedom from biochemical relapse survival rate, we found statistically differences between pT3a and pT3b (p < 0,0001). In pT3a patients, we found no differences between PSA levels > 20 ng/ml, versus < 20 (p = 0,415), and statistically differences between pathological Gleason 6 or greater, versus < 6 (p = 0,048). However, we found no differences when we used both criteria (PSA and Gleason) (p = 0,195). ConclusionsWe support for early adyuvant hormonal therapy in pT3b patients. In pT3a, the hormonotherapy may be used if appears biochemical failure, specially with adverse prognostic factors (PSA and Gleason).

Prognosis of bladder cancer. III. The value of radical cystectomy in the management of invasive bladder cancer.

From January 1979 to June 1982, 141 consecutive patients with bladder transitional cell carcinoma were treated with a single stage lymphadenectomy plus radical cystectomy. The survival rate observed in our patients, based on the TNM classification, was comparable with that reported for other groups employing contemporary surgery. Survivorship for patients with deep invasive tumors was also estimated by breaking down the pT3 stage, and patients with tumor confined to the bladder wall (pT3a) were separately evaluated from those with tumor extended outside (pT3b). The results obtained with this subdivision showed that pT3a patients have almost the same survival rate as pT2 patients. From these results it is concluded that radical cystectomy is a satisfactory curative treatment of bladder cancer confined to the bladder wall, whatever the extension of the muscular involvement. Such considerations suggest that, in order to achieve a more objective analysis of the results after radical cystectomy for invasive bladder cancer, a modification of clinical staging is necessary. Moreover, a simplification of the classification methods should provide a better identification of the elements required to assess the prognosis and to improve treatment planning.