The ability of the American Joint Committee On Cancer Staging system to predict progression‐free survival after radical prostatectomy

Abstract

Objective To examine, in a retrospective analysis of outcome based on prostate-speci®c antigen (PSA) levels, whether the 1992 and revised 1997 staging criteria for prostate cancer can be used to predict progression-free survival for patients after radical prostatectomy for pT2 and pT3 prostate cancer. Patients and methods In all, 291 patients with a PSA determination during a 6-month interval after radical prostatectomy were analysed (mean followup 5.2 years). In the absence of a uniform system of pathological staging, the histopathological stage was de®ned according to the 1992 and 1997 American Joint Cancer Committee/Union Internationale Contre le Cancer (AJCC/UICC) tumour-nodes-metastases (TNM) staging classi®cation. Findings were correlated with the PSA value after surgery. The subgroups of pT2 and pT3 disease were compared for the time to PSA progression, using Kaplan-Meier data analysis and the log-rank test. Results The biochemical progression-free 5-year survival rates for stage pT2 were 83% (pT2a), 81% (pT2b) and 62% (pT2c); there were no signi®cant differences in the pT2 subgroups. The recurrence-free rates for pT3were 79% (pT3a), 65% (pT3b) and 50% (pT3c); the actuarial recurrence-free rate was signi®cantly different for patients with 1997 AJCC pT3a vs pT3b disease (P=0.0132). There was no signi®cant difference in the 1992 AJCC stages pT2a vs pT2b (P=0.1232) and the recurrence-free rate was not signi®cantly different for patients with 1992 AJCC pT3a vs pT3b disease (P=0.9). There was a signi®cant difference in the likelihood of a PSA relapse between patients with positive and negative surgical margins (P=0.131). Conclusion These results support the current revised 1997 AJCC/UICC staging system for prostate cancer.There is an urgent need to develop a pathological equivalent to the AJCC/UIC TNM clinical staging system. Greater clinical input and evaluation from different institutions are essential to reach consensus on pathological staging categories that maximize the predictability of outcome after de®nitive therapy. Crucial issues are the de®nition and quanti®cation of extraprostatic extension and de®nition of surgical margin categories.

Comparative assessment of the 1992 and 2002 pathologic T3 substages for the prediction of biochemical recurrence after radical prostatectomy

“…Those studies showed no prognostic difference between both groups. 11,12 We conducted this retrospective study to evaluate the prognostic impact of the AJCC 1992 criteria for pathologic staging in 3546 consecutive patients with PCa who underwent RP in a European center of excellence. We also tested whether these substage designations were associated with differences in the BCR rate after controlling for pretreatment PSA level, pathologic Gleason grade, surgical margin status, and/or LNI.…”

Should pathologists continue to use the current pT2 substaging system for reporting of radical prostatectomy specimens?

“…It has been argued that the prognostic significance of clinical substaging by DRE and TRUS of T2 cancers is a direct effect of understaging (4). The paper surveyed was a platform presentation at the 99th Annual Meeting of the United States and Canadian Academy of Pathology held in Washington DC, 2010, and is supported by several other previous studies (5)(6)(7)(8). The conclusions included no significant difference for several clinicopathological variables and time of biochemical progression following surgery between patients with pathologic stage T2a/pT2b and patients with pathologic stage T3c.…”

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume

“…23 This, however, does not hold true for the pathological substaging of pT2 cancers, as these cancers seem to represent a clinically (but not necessarily pathologically) homogeneous group with an overall good prognosis. 19,24 From a biological perspective the current criteria for pT2 seem somewhat confusing. Multifocality of prostate cancer is commonplace, being found in 80% of prostatectomy specimens.…”

“…[24][25][26] This observation points at a lack of uniform criteria used to define pT2 substaging, giving rise to poor reproducibility. In particular, the criteria to distinguish prostate cancers involving less than a half lobe from those involving more than a half lobe are not well defined and are not applied consistently.…”