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Identification Of Patients At High Risk Of Prostate Cancer-Specific Mortality After Radical Retropubic Prostatectomy
Matthew Nielsen, Michael Muntener*, Elizabeth Humphreys, Leslie Mangold, Patrick C Walsh, Alan W. Partin
Johns Hopkins, Baltimore, MD
Introduction: We sought to develop a model to identify a cohort of patients at high risk of prostate cancer (CaP)-specific mortality after radical retropubic prostatectomy for clinically localized disease.
Methods: Proportional hazards analysis was applied to a cohort of patients to develop a multifactorial predictive model to identify men with the highest risk of CaP-specific mortality. Patients with organ-confined Gleason 6 disease were excluded as they had 100% CaP specific survival. The modeling cohort therefore included 3258 men, of whom 87 died of prostate cancer. Variables were removed in a stepwise fashion when they failed to explain differences in the risk of CaP-specific mortality
Results: Prostatectomy Gleason score, seminal vesicle invasion and lymph node metastasis were significant independent predictors of CaP-specific mortality on multivariate analysis. A model for weighted risk of CaP-specific mortality was developed based on coefficients of logistic regression: Mr= RRP Gleason score 4+3 (0/1) x 1.4 + RRP Gleason score 8-10 (0/1) x 2.1 + seminal vesicle involvement (0/1) x 0.8 + lymph node involvement (0/1) x 0.86. Kaplan-Meier analyses demonstrated rapid deviation of the curves based on the Mr. Men with an Mr greater than 2.75 demonstrated a 23.6% CaP-specific mortality rate at 10 years, versus 2.8% for those with a value of less than 2.75.
Conclusions: We have developed a Cox proportional hazards model that successfully stratifies patients based upon their risk of CaP-specific mortality. Application of this model should provide information useful for patient selection and the design of trials of adjuvant therapies
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