The CAPRA-S Score and Immune Dysfunction as a Guide to Outcome in Men Treated with Prostatectomy Radical as Mono-Therapy for Prostate Cancer

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dc.contributor.authorMurray, Nigel P.
dc.contributor.authorAedo, Sócrates
dc.contributor.authorFuentealba, Cynthia
dc.contributor.authorReyes, Eduardo
dc.contributor.authorSalazar, Aníbal
dc.date.accessioned2022-12-01T13:28:27Z
dc.date.available2022-12-01T13:28:27Z
dc.date.issued2022-08
dc.description.abstractObjective: Incorporate the immune function as determined by the absolute lymphocyte count (ALC) into the CAPRA-S risk stratification score to determine if predictive values could be improved. Materials and Methods: The clinical pathological findings in the surgical specimen and total PSA were used to define the three CAPRA-S risk groups. One month after surgery and at each follow up total PSA and the ALC were determined, until biochemical failure (BF) or the end of the study period. A cut off value of<1,000 lymphocytes/mm3 was used to define lymphocytopenia (LCP). Each CAPRA-S group was sub- ivided based on the presence or absence of LCP. Kaplan-Meier biochemical failure free survival (BFFS) curves and restricted mean biochemical failure free survival times were calculated for each group. Results: 404 patients participated of whom 103 (25.5%) underwent BF. 270 men were CAPRA-S low risk (LR), 89 intermediate risk (IR) and 45 high risk (HR), of whom LCP was found in 22 (8%) of low risk, 24 (27%) of intermediate risk and 17 (38%) of high risk men. LCP was significantly associated with a higher PSA, higher Gleason and CAPRA-S scores and BF. HRs were 1.76 for IR, 2.49 for HR and 1.29 for LCP. Five-year BFFS for men without LCP, LR 93.5%, IR 61% and HR 36%, for those with LCP, LR 55%, IR 25% and HR 6%. All patients with LCP and IR or HR scores relapsed within 6 years. 10 year BFFS for men without LCP were 71% LR, 43% IR and 23% HR, LR with LCP 16%. Men with BF had increasing LCP approximately 18 months before BF. Conclusions: The incorporation of the ALC taken one month after surgery with the CAPRA-S improves risk stratification; decreases in the ALC suggest that BF is occuring. These results need to be confirmed with larger studies. en
dc.description.abstractObjetivo: Establecer el riesgo de recidiva bioquímica (RBQ) basado en la puntuación CAPRA-S (riesgo bajo (RB) , riesgo intermedio (RI) y riesgo alto (RA) y recuento absoluto de linfocitos (RAL) ≤1000 por mm3 (definida como linfocitipenia LCP). Material y Métodos: Entre 2005 y 2020, se realiza un estudio observacional prospectivo de sujetos con cáncer prostático tratado con cirugía. Se registran los hallazgos del espécimen quirúrgico y el PSA para definir la CAPRA-S. Un mes pos-cirugía y durante el seguimiento el PSA y RAL fueron determinados hasta la RBQ o final del estudio. Se construye un modelo de supervivencia flexible paramétrico (FP) para predecir la RBQ a 5 años utilizando la puntuación CAPRA-S y la LCP. Se evalúan mediante regresión local ponderada mediciones repetidas de los RAL y el tiempo a RBQ o fin del estudio. Resultados: De los 404 participantes observaron 103 (25,5%) RBQ. Puntajes de la CAPRA-S: 270 RB, 89 RI y 45 RA. La LCP estaba asociada con niveles elevados del PSA, puntuación Gleason, márgenes comprometidos, extensión extracapsular, invasión de vesículas seminales y nodos linfáticos. El modelo FP incorporo en forma independiente y significativa ( coeficiente con valor P<0,01) la LCP ( 1,29), RA (2,49), RI (1,76) y RB (1); mostrando una C de Harrell de 0,81 con adecuada validez. la media restringida en años (MR) para ocurrencia de RBQ, como la supervivencia predicha (SP) a 5 años fueron: sin LCP RA (MR: 3,63; SP 42,1%) RI (MR 4,3; SP 63,1%) RB (MR 4,83; SP 91,7%) con LCP RA (MR 2,1; SP 4,34%) RI (MR 3,14; SP 18,9%) y RB (MR 4,42; SP 73,1%). Los sujetos con RBQ tuvieron LCP 18 meses previo a la RBQ. Conclusiones: LCP más CAPRA-S predicen la RB en sujetos tratado con cirugía Palabras: 290es
dc.identifier.citationArchivos Españoles de Urología, Vol. 75, N°6 (2022) p. 507-516. es
dc.identifier.doihttps://doi.org/10.56434/j.arch.esp.urol.20227506.75
dc.identifier.issn1576-8260
dc.identifier.orcidhttps://orcid.org/0000-0001-8154-8550
dc.identifier.orcidhttps://orcid.org/0000-0001-5567-3374
dc.identifier.urihttp://hdl.handle.net/20.500.12254/2612
dc.language.isoeses
dc.publisherArchivos Españoles de Urología
dc.rightsAtribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)
dc.rights.urihttp://creativecommons.org/licenses/by-nc-sa/3.0/cl/
dc.subject.otherCAPRA-Sen
dc.subject.otherProstate canceren
dc.subject.otherAbsolute lymphocyte counten
dc.subject.otherPrognosisen
dc.subject.otherBiochemical failureen
dc.subject.otherCáncer prostáticoes
dc.subject.otherRecuento absoluto de linfocitoses
dc.subject.otherPronósticoes
dc.subject.otherRecidiva bioquímicaes
dc.titleThe CAPRA-S Score and Immune Dysfunction as a Guide to Outcome in Men Treated with Prostatectomy Radical as Mono-Therapy for Prostate Canceren
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