Analysis of clinical stage T2 prostate cancer: Do current subclassifications represent an improvement? Journal Article

Authors: Cagiannos, I.; Graefen, M.; Karakiewicz, P. I.; Ohori, M.; Eastham, J. A.; Rabbani, F.; Fair, W.; Wheeler, T. M.; Hammerer, P. G.; Haese, A.; Erbersdobler, A.; Huland, H.; Scardino, P. T.; Kattan, M. W.
Article Title: Analysis of clinical stage T2 prostate cancer: Do current subclassifications represent an improvement?
Abstract: Purpose: The purpose of this study was to determine whether the extent of palpable cancer within the prostate predicts outcome after radical prostatectomy. Patients and Methods: We combined prospectively collected data on 1,755 consecutive clinical stage T2 patients treated with radical prostatectomy alone at four institutions. According to the 1992 American Joint Committee on Cancer tumor-node-metastasis system, 645 (37%) were T2a, 758 (43%) were T2b, and 352 (20%) were T2c. Kaplan-Meier and proportional hazards regression analyses were performed on the 1992 and 1997 T2 subclassifications. After controlling for the effects of prostate-specific antigen (PSA) and biopsy Gleason sum, the two staging systems were compared for their ability to predict recurrence-free survival (RFS). Adjusted RFS curves were constructed using the corrected group prognosis method. Results: Follow-up ranged from 1 to 166 months (median, 26 months). Cancer recurred in 417 (24%) of the T2 patients. The 1992 (P = .005) but not the 1997 (P = .100) T2 subclassification predicted outcome after controlling for PSA and Gleason sum. After covariate adjustment, RFS was 7% higher at 5 years in the 1992 T2a subcategory relative to the T2b subcategory. Conclusion: The 1992 American Joint Committee on Cancer system is superior to the 1997 system, and the former adds prognostic information to a model containing pretreatment PSA and Gleason sum. These results suggest that 1992 T2 subclassification derived from palpable findings improves prognostication over the 1997 subclassification. © 2002 by American Society of Clinical Oncology.
Keywords: adult; cancer survival; controlled study; aged; survival analysis; major clinical study; cancer staging; follow up; neoplasm staging; prostate specific antigen; proportional hazards models; prostate cancer; prostatic neoplasms; survival time; prostatectomy; humans; prognosis; human; male; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 20
Issue: 8
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2002-04-15
Start Page: 2025
End Page: 2030
Language: English
DOI: 10.1200/jco.2002.08.123
PUBMED: 11956261
PROVIDER: scopus
Notes: Export Date: 14 November 2014 -- Source: Scopus
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MSK Authors
  1. Markus Graefen
    11 Graefen
  2. Peter T Scardino
    622 Scardino
  3. Farhang Rabbani
    82 Rabbani
  4. Makoto Ohori
    50 Ohori
  5. James Eastham
    429 Eastham
  6. Michael W Kattan
    218 Kattan
  7. William R Fair
    202 Fair