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

Objective To examine, in a retrospective analysis of outcome based on prost ate-specific antigen (PSA) levels. whether the 1992 and revised 1997 stagin g criteria for prostate cancer can be used to predict progression-free surv ival for patients after radical prostatectomy for pT2 and pT3 prostate canc er. 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 histopathologic al stage was defined according to the 1992 and 1997 Americ an Joint Cancer Committee/Union Internationale Contre le Cancer (AJCC/UICC) tumour-nodes-metastases TNM) staging classification. Findings were correla ted 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 anal ysis and the log-rank test. Results The biochemical progression-free 5-year survival rates for stage pT 2 were 83% (pT2a), 81%, (pT2b) and 62% (pT2c): there were no significant di fferences in the pT2 subgroups. The recurrence-free rates for pT3 were 79% (PT3a). 65% (pT3b) and 50%, (pT3c); the actuarial recurrence-free rate was significantly different for patients with 1997 AJCC pT3a vs pT3b disease (P =0.0132). There was no significant difference in the 1992 AJCC stages pT2a vs pT2b (P=0.1232) and the recurrence-free rate was not significantly diffe rent for patients with 1992 AJCC pT3a vs pT3b disease (P=0.9). There was a significant 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 pathologi cal equivalent to the AJCC/UIC TNM clinical staging system. Greater clinica l input and evaluation from different institutions are essential to reach c onsensus on pathological staging categories that maximize the predictabilit y of outcome after definitive therapy. Crucial issues are the definition an d quantification of extraprostatic extension and definition of surgical mar gin categories.