한국인 전립선암 환자에서 술 전 중등도위험군에서 술 후 고위험군으로 이행할 수 있는 인자

Purpose: We aimed to examine a change and relevant predictors in intermediate-risk prostate cancer which have a wide range of treatment options from active surveillance to radical prostatectomy (RP). Materials and Methods: Of 1,159 patients who underwent RP in multi-institution between January 2009 and December 2012, 390 patients who were classified as intermediate-risk prostate cancer group by preoperative evaluation according to NCCN guideline were enrolled in this retrospective study. The rates of Gleason score upgrading, upstaging and migrating to high-risk prostate cancer group at final pathology and there risk factors were assessed. Results: The mean age of enrolled patients were 67.33±6.17 years with mean PSA level of 9.34±4.34 ng/ml. The number of patients with worsening upgrading, worsening upstaging and worsening prognosis were 42 (10.77%), 83 (21.28%) and 108 (27.7%), respectively. In analysis compared between upgrading group and non-upgrading group, there was no difference in patient’s features. However, in analysis on upstaging and worsening prognosis, serum PSA (p=0.029, p=0.042) and %positive biopsy core (p=0.010, p=0.013) showed significant difference. In univariable analysis, serum PSA (p=0.030, p=0.042) and %positive biopsy core (p=0.004, p=0.014) were predictive of upstaging and worsening prognosis, also, in multivariable analysis, serum PSA (p=0.016) and %positive biopsy core (p=0.042) were statistically relevant factors of worsening upstaging. Conclusions: In this study, 27.7% of patients with preoperative intermediate-risk prostate cancer were re-stratified into high-risk prostate cancer group after RP. Serum PSA and %positive biopsy core were the predictive factors for migrating to high risk group.