对两项随机 STAMPEDE 平台试验的荟萃分析显示，除雄激素剥夺疗法和放射疗法外，醋酸阿比特龙 3 年可显着改善高危非转移性前列腺癌 (PCa) 的无转移生存率和总生存率 (OS)，因此应该被认为是一种新的护理标准。我们研究的目的是评估新诊断的符合 STAMPEDE 高风险标准的非转移性淋巴结阴性 PCa 的手术治疗患者的长期癌症特异性生存 (CSS) 和 OS。这是一项针对患者的回顾性、多中心队列研究欧洲泌尿外科协会 (EAU) 的高危 PCa 患者接受了根治性前列腺切除术和扩大盆腔淋巴结清扫术。使用累积发生率曲线评估 CSS，并使用 Kaplan-Meier 方法评估 OS。我们使用 Fine and Gray 模型评估 STAMPEDE 高危因素 (SHRF) 对 CSS 的预后价值，并使用 Cox 比例风险模型评估 SHRF 与 OS 的关联。总共 2994 名 EAU 高危患者PCa 被分为具有 0、1、2 或 3 个 SHRF 的组。 SHRF 为 0-1 次和 2-3 次的患者的 10 年生存率估计分别为 CSS 95% 和 82%，OS 分别为 81% 和 64%（均 p<0.0001）。与 SHRF 为 0 的患者相比，CSS 的风险比分别为 1.2 (p=0.5)、3.9 (p<0.0001) 和 5.5 (p<0.0001)，以及 1.1 (p=0.4)、2.2 (p<0.0001)、对于具有 1、2 和 3 个 SHRF 的患者，OS 分别为 2.5 (p=0.0004)。我们的结果证实，STAMPEDE 高风险标准识别出具有高度侵袭性 PCa 特征和不良长期肿瘤结局的患者亚组。该人群可能从积极的多模式治疗中受益最多。尽管如此，我们首次证明手术对于 STAMPEDE 高风险 PCa 患者来说仍然是一种可行的治疗选择。符合 STAMPEDE 试验高风险定义的前列腺癌是一种侵袭性癌症。我们的长期癌症控制结果表明，手术对于此类前列腺癌患者亚组来说是一种可行的选择。版权所有 © 2024 欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。

A meta-analysis of two randomized STAMPEDE platform trials revealed that 3 yr of abiraterone acetate in addition to androgen deprivation therapy and radiation therapy significantly improved metastasis-free and overall survival (OS) in high-risk nonmetastatic prostate cancer (PCa) and should be considered a new standard of care. The aim of our study was to assess long-term cancer-specific survival (CSS) and OS for surgically treated patients with newly diagnosed nonmetastatic node-negative PCa meeting the STAMPEDE criteria for high risk.This was a retrospective, multicenter cohort study of patients with European Association of Urology (EAU) high-risk PCa who underwent radical prostatectomy and extended pelvic lymph node dissection. CSS was assessed using cumulative incidence curves and the Kaplan-Meier method was used to evaluate OS. We used a Fine and Gray model to evaluate the prognostic value of STAMPEDE high-risk factors (SHRFs) for CSS, and a Cox proportional-hazards model to assess the association of SHRFs with OS.A total of 2994 patients with EAU high-risk PCa were divided into groups with 0, 1, 2, or 3 SHRFs. The 10-yr survival estimates for patients with 0-1 versus 2-3 SHRFs were 95% versus 82% for CSS and 81% versus 64% for OS (both p < 0.0001). In comparison to patients with 0 SHRFs, hazard ratios were 1.2 (p = 0.5), 3.9 (p < 0.0001), and 5.5 (p < 0.0001) for CSS, and 1.1 (p = 0.4), 2.2 (p < 0.0001), and 2.5 (p = 0.0004) for OS for patients with 1, 2, and 3 SHRFs, respectively.Our results confirm that the STAMPEDE high-risk criteria identify a subgroup of patients with highly aggressive PCa features and adverse long-term oncological outcomes. This population is likely to benefit most from aggressive multimodal treatment. Nevertheless, we have shown for the first time that surgery remains a viable treatment option for patients with STAMPEDE high-risk PCa.Prostate cancer that meets the high-risk definitions from the STAMPEDE trial is an aggressive type of cancer. Our results for long-term cancer control outcomes indicate that surgery is a viable option for the subgroup of patients with this type of prostate cancer.Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.