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Metastatic progression, cancer-specific mortality and need for secondary treatments in patients with clinically high-risk prostate cancer treated initially with radical prostatectomy
Progresión metastática, mortalidad cáncer específica y necesidad de tratamientos de segunda línea en pacientes con cáncer de próstata de alto riesgo tratados inicialmente mediante prostatectomía radical
J. Rubio-Briones
Corresponding author
jrubio@fivo.org

Corresponding author.
, I. Iborra, M. Trassierra, A. Collado, J. Casanova, A. Gómez-Ferrer, J.V. Ricós, J.L. Monrós, R. Dumont, E. Solsona
Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
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        "resumen" => "<span class="elsevierStyleSectionTitle">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine our results in high risk &#40;HR&#41; prostate cancer &#40;PCa&#41; patients treated with radical prostatectomy &#40;RP&#41; and to establish preoperative prognosis factors&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of 925 RP&#46; Mean follow-up for the HR group was 89&#46;8&#43;&#47;&#8722;53&#46;6 months&#46; Following NCCN criteria&#44; we operated 210 &#40;22&#46;7&#37;&#41; HR and 715 &#40;77&#46;3&#37;&#41; low&#47;intermediate risk patients&#46; The endpoint was metastatic progression&#46; Kaplan-Meier method for survival comparison among groups and Cox regression model for multivariate analysis of preoperative prognostic factors were used&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Revised period&#59; 1986&#8211;2007&#46; Fifty-four patients &#40;25&#46;7&#37;&#41; were free of disease and 8 patients &#40;3&#46;8&#37;&#41; died for other causes free of disease&#46; Disease progressed in 148 patients &#40;70&#46;5&#37;&#41;&#59; death due to tumour progression occurred in 42 cases &#40;20&#37;&#41; and due to other causes in 25 patients &#40;11&#46;9&#37;&#41;&#46; Seventy-nine patients in HR group &#40;38&#37;&#41; vs 549 low&#47;intermediate risk group &#40;78&#46;5&#37;&#41; did not deserve further treatments &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The uni and multivariate analysis for metastatic progression showed both Gleason score at biopsy &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;922&#59; 95&#37; CI 1&#46;106&#8211;3&#46;341&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;020&#41; and clinical stage &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;290&#59; 95&#37; CI 1&#46;269&#8211;4&#46;133&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41; showed independent prognostic value for metastatic progression&#44; but not PSA&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">An HR patient can be cured in a third of the cases and will need multimodal treatments in more than half of the times&#46; We prompt surgery in a young healthy patient with a resectable tumour&#44; mainly if just one bad prognostic factor is present and defiantly if this is just PSA elevation&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar nuestros resultados en pacientes con c&#225;ncer de pr&#243;stata &#40;CaP&#41; de alto riesgo &#40;AR&#41; tratados mediante prostatectom&#237;a radical &#40;PR&#41; y establecer criterios pron&#243;sticos preoperatorios&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de 925 PR&#46; El seguimiento medio fue 89&#44;8&#43;&#47;&#8722;53&#44;6 meses para el grupo de CaP de AR&#46; Siguiendo los criterios NCCN&#44; operamos 210 &#40;22&#44;7&#37;&#41; PR de AR y 715 &#40;77&#44;3&#37;&#41; de riesgo bajo&#47;intermedio&#46; Se utiliz&#243; el m&#233;todo Kaplan-Meier para an&#225;lisis de supervivencia y el modelo de Cox para el an&#225;lisis multivariado de factores pron&#243;sticos para progresi&#243;n metast&#225;tica&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Periodo revisado&#59; 1986&#8211;2007&#46; Cincuenta y cuatro pacientes de AR &#40;25&#44;7&#37;&#41; estaban libres de progresi&#243;n y 8 pacientes &#40;3&#44;8&#37;&#41; murieron por otras causas libres de enfermedad&#46; El CaP progres&#243; en 148 pacientes &#40;70&#44;5&#37;&#41;&#46; Murieron por progresi&#243;n tumoral 42 pacientes &#40;20&#37;&#41; y por otras causas 25 pacientes &#40;11&#44;9&#37;&#41;&#46; Setenta y nueve pacientes de AR &#40;38&#37;&#41; frente a 549 de riesgo bajo&#47;intermedio &#40;78&#44;5&#37;&#41; no necesitaron m&#225;s l&#237;neas de tratamiento &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Los an&#225;lisis uni y multivariados demostraron que tanto el score Gleason en biopsia &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;922&#59; IC 95&#37; 1&#44;106&#8211;3&#44;341&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;020&#41; como el estadio cl&#237;nico &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;290&#59; IC 95&#37; 1&#44;269&#8211;4&#44;133&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41; mostraron valor pron&#243;stico independiente para progresi&#243;n metast&#225;sica&#44; pero no el PSA&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Un paciente con CaP de AR que se opere tiene un 25&#37; de posibilidades de curarse y podr&#225; necesitar un tratamiento multimodal en m&#225;s de la mitad de los casos&#46; Recomendamos PR en un paciente joven si el tumor se considera resecable&#44; sobre todo si el &#250;nico factor pron&#243;stico que lo encasilla como AR es la elevaci&#243;n del PSA&#46;</p>"
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