Analysis of influencing factors and predictive efficacy of biochemical persistence/recurrence after radical resection for high-risk localized prostate cancer

doi:10.3760/cma.j.cn371439-20250616-00025

Abstract

Abstract:

Objective To investigate the influencing factors and predictive efficacy of biochemical persistence/recurrence （BPR） after radical resection for high-risk localized prostate cancer （HR-LPCa），and to analyze the clinical performance of a nomogram model constructed based on the influencing factors in predicting postoperative BPR.Methods A total of 172 patients with HR-LPCa who underwent radical resection at Baotou City Central Hospital，Inner Mongolia Autonomous Region from January 2016 to January 2023 were selected as research subjects. Clinicopathological characteristics were compared between patients with and without BPR，and binary logistic regression was used to analyze the influencing factors of postoperative BPR in HR-LPCa patients. A nomogram model was constructed based on the results of multivariate analysis. The receiver operator characteristic （ROC） curve was used to evaluate the predictive efficacy of the model，and the calibration curve was used to assess the accuracy and practicality of the model.Results Among the 172 patients，42 developed biochemical persistence，32 had biochemical recurrence，and 4 progressed to castration resistance. There were statistically significant differences between patients with BPR （n=74） and without BPR （n=98） in baseline prostate-specific antigen density （PSAD）（t=6.93，P<0.001），pathological International Society of Urological Pathology （ISUP） grade （χ²=17.31，P<0.001），and surgical margin status （χ²=29.29，P<0.001）. Multivariate analysis showed that，baseline PSAD （OR=0.01，95%CI： 0.00-0.04，P<0.001），pathological ISUP grade （OR=0.27，95%CI： 0.12-0.61，P=0.002），and surgical margin status （OR=0.18，95%CI： 0.08-0.40，P<0.001） were independent influencing factors for BPR after radical resection in HR-LPCa patients. Based on the multivariate analysis results，a nomogram model was constructed to predict the risk of BPR after radical resection in HR-LPCa patients，logit（P）=4.84-5.99×baseline PSAD-1.32×pathological ISUP grade-1.72×surgical margin status. The ROC curve analysis showed that，the area under the curve （AUC） values of baseline PSAD，pathological ISUP grade，surgical margin status，and the nomogram model for predicting BPR after radical resection in patients with HR-LPCa were 0.76，0.66，0.71，and 0.88，respectively. The AUC of the nomogram model was significantly higher than that of each of the other three indicators alone （Z=-3.62，P<0.001； Z=-4.59，P<0.001； Z=-2.36，P<0.001）. The nomogram model exhibited a C-index of 0.878 and excellent goodness-of-fit （Hosmer-Lemeshow χ²=3.51，P=0.752）. Calibration curves demonstrated that the predicted curve of the nomogram model closely approximated the ideal reference line without significant deviation，indicated good predictive accuracy.Conclusions Baseline PSAD，pathological ISUP grade，and surgical margin status are all independent influencing factors for BPR after radical resection in HR-LPCa patients. The nomogram model constructed based on the above clinicopathological indicators shows good predictive performance.

Key words: Prostatic neoplasms, Root cause analysis, Biochemical persistence, Biochemical recurrence

Guo Xuetao, Qiao Julong, Shao Hongjiang, Wang Xin, Su Riguge, Liu Lu, Liang Lu. Analysis of influencing factors and predictive efficacy of biochemical persistence/recurrence after radical resection for high-risk localized prostate cancer[J]. Journal of International Oncology, 2026, 53(3): 157-162.

Figures/Tables 6

References 21

[1]	Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024[J]. CA Cancer J Clin, 2024, 74(1): 12-49. DOI: 10.3322/caac.21820.
[2]	Liu X, Yu C, Bi Y, et al. Trends and age-period-cohort effect on incidence and mortality of prostate cancer from 1990 to 2017 in China[J]. Public Health, 2019, 172: 70-80. DOI: 10.1016/j.puhe.2019.04.016. pmid: 31220754
[3]	Emam A, Hermann G, Attwood K, et al. Oncologic outcome of radical prostatectomy versus radiotherapy as primary treatment for high and very high risk localized prostate cancer[J]. Prostate, 2021, 81(4): 223-230. DOI: 10.1002/pros.24089. pmid: 33471385
[4]	Kim WT, Kim J, Kim WJ. How can we best manage biochemical failure after radical prostatectomy?[J]. Investig Clin Urol, 2022, 63(6): 592-601. DOI: 10.4111/icu.20220294. pmid: 36347548
[5]	那彦群, 叶章群, 孙颖浩, 等. 2014版中国泌尿外科疾病诊断治疗指南[M] 北京: 人民卫生出版社, 2013.
[6]	Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013[J]. Eur Urol, 2014, 65(1): 124-137. DOI: 10.1016/j.eururo.2013.09.046. pmid: 24207135
[7]	Mottet N, Bergh R, Briers E, et al. EAU-ESTRO-SIOG guidelines on prostate cancer[M]. Arnhem, the Netherlands: European Association of Urology, 2018: 1-146.
[8]	Tilki D, Chen MH, Wu J, et al. Persistent prostate-specific antigen following radical prostatectomy for prostate cancer and mortality risk[J]. JAMA Oncol, 2025, 11(5): 502-510. DOI: 10.1001/jamaoncol.2025.0110. pmid: 40080000
[9]	Roberts MJ, Papa N, Veerman H, et al. Prediction of biochemical recurrence after radical prostatectomy from primary tumour characte-ristics[J]. BJU Int, 2024, Suppl 2(Suppl 2): 47-55. DOI: 10.1111/bju.16482.
[10]	McCormick BZ, Mahmoud AM, Williams SB, et al. Biochemical recurrence after radical prostatectomy: current status of its use as a treatment endpoint and early management strategies[J]. Indian J Urol, 2019, 35(1): 6-17. DOI: 10.4103/iju.IJU_355_18.
[11]	Takeda H, Akatsuka J, Yuki E, et al. Long-term oncological outcomes for histologically confirmed high-risk prostate cancer[J]. J Nippon Med Sch, 2023, 90(2): 202-209. DOI: 10.1272/jnms.JNMS.2023_90-210.
[12]	Sood A, Grauer R, Diaz-Insua M, et al. 15-year biochemical failure, metastasis, salvage therapy, and cancer-specific and overall survival rates in men treated with robotic radical prostatectomy for PSA-screen detected prostate cancer[J]. Prostate Cancer Prostatic Dis, 2023, 26(4): 778-786. DOI: 10.1038/s41391-023-00674-2.
[13]	Moris L, Cumberbatch MG, Van den Broeck T, et al. Benefits and risks of primary treatments for high-risk localized and locally advanced prostate cancer: an international multidisciplinary systematic review[J]. Eur Urol, 2020, 77(5): 614-627. DOI: 10.1016/j.eururo.2020.01.033. pmid: 32146018
[14]	Matsumoto K, Niwa N, Hagiwara M, et al. Long-term follow-up comparing salvage radiation therapy and androgen-deprivation therapy for biochemical recurrence after radical prostatectomy[J]. Int J Clin Oncol, 2021, 26(4): 744-752. DOI: 10.1007/s10147-020-01839-y. pmid: 33387085
[15]	Marra G, Valerio M, Heidegger I, et al. Management of patients with node-positive prostate cancer at radical prostatectomy and pelvic lymph node dissection: a systematic review[J]. Eur Urol Oncol, 2020, 3(5): 565-581. DOI: 10.1016/j.euo.2020.08.005. pmid: 32933887
[16]	Efstathiou E, Davis JW, Pisters L, et al. Clinical and biological characterisation of localised high-risk prostate cancer: results of a randomised preoperative study of a luteinising hormone-releasing hormone agonist with or without abiraterone acetate plus prednisone[J]. Eur Urol, 2019, 76(4): 418-424. DOI: 10.1016/j.eururo.2019.05.010. pmid: 31176622
[17]	Preisser F, Coxilha G, Heinze A, et al. Impact of positive surgical margin length and Gleason grade at the margin on biochemical recurrence in patients with organ-confined prostate cancer[J]. Prostate, 2019, 79(16): 1832-1836. DOI: 10.1002/pros.23908. pmid: 31553506
[18]	Omri N, Kamil M, Alexander K, et al. Association between PSA density and pathologically significant prostate cancer: the impact of prostate volume[J]. Prostate, 2020, 80(16): 1444-1449. DOI: 10.1002/pros.24078.
[19]	王方明, 韩苏军, 杨飞亚, 等. 高危前列腺癌腹腔镜根治性前列腺切除术后切缘阳性的危险因素[J]. 中华泌尿外科杂志, 2021, 42(5): 349-354. DOI: 10.3760/cma.j.cn112330-20201013-00716.
[20]	Martini A, Gandaglia G, Fossati N, et al. Defining clinically mea-ningful positive surgical margins in patients undergoing radical prostatectomy for localised prostate cancer[J]. Eur Urol Oncol, 2021, 4(1): 42-48. DOI: 10.1016/j.euo.2019.03.006.
[21]	McKay RR, Xie W, Ye H, et al. Results of a randomized phase Ⅱ trial of intense androgen deprivation therapy prior to radical prostatectomy in men with high-risk localized prostate cancer[J]. J Urol, 2021, 206(7): 80-87. DOI: 10.1097/JU.0000000000001702.

临床病理特征	生化持续/复发（n=74）	未生化持续/复发（n=98）	t/χ²值	P值
年龄（岁）^a	65.69±8.16	66.12±8.54	-0.33	0.739
体质量指数（kg/m²）^a	24.70±3.20	24.31±3.46	0.76	0.451
实验室指标^a
基线PSA水平（ng/ml）	15.29±5.46	14.03±3.12	1.91	0.058
基线PSAD[ng/（ml·cm³）]	0.68±0.20	0.51±0.12	6.93	<0.001
基线睾酮水平（ng/ml）	4.51±0.87	4.60±0.93	-0.65	0.519
穿刺阳性针数百分比（%）^a	59.21±10.64	57.70±9.82	0.96	0.337
穿刺病灶线性长度最大占比（%）^a	84.21±15.64	82.70±14.82	0.65	0.519
病理ISUP分级^b
1~3级	32	73	17.31	<0.001
4~5级	42	25	17.31	<0.001
病理分期^b
<T_3a期	37	58	1.44	0.230
≥T_3a期	37	40	1.44	0.230
淋巴结转移^b
是	8	4	2.94	0.086
否	66	94	2.94	0.086
切缘状态^b
阳性	55	32	29.29	<0.001
阴性	19	66	29.29	<0.001

影响因素	β值	SE值	Wald χ²值	OR值	95%CI	P值
基线PSAD	-5.99	1.36	19.32	0.01	0.00~0.04	<0.001
病理ISUP分级	-1.32	0.42	9.91	0.27	0.12~0.61	0.002
切缘状态	-1.72	0.42	17.20	0.18	0.08~0.40	<0.001
常量	4.84	0.90	28.65	126.00	-	<0.001

项目	最佳截断值	AUC	P值	敏感性（%）	特异性（%）	约登指数（%）
基线PSAD	0.56 ng/（ml·cm³）	0.76	<0.001	74.32	72.45	46.77
病理ISUP分级	-	0.66	<0.001	56.76	74.49	31.25
切缘状态	-	0.71	<0.001	74.32	67.35	41.67
列线图模型	-	0.88	<0.001	74.32	87.76	62.08