Hanus M C, Zagars G K, Pollack A
Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Int J Radiat Oncol Biol Phys. 1999 Jan 15;43(2):379-83. doi: 10.1016/s0360-3016(98)00408-8.
To compare the outcome of familial versus sporadic prostate carcinoma after definitive external radiation.
Between 1987 and 1996, 1214 men with clinically localized prostate cancer (T1-T4, N0/NX, M0) received definitive radiation therapy in our department. By retrospective review of charts and questioning of patients, a record on the presence or absence of prostate cancer in a first degree relative was obtained in 1164 men. Univariate and multivariate analysis was performed on these cases with relapse or rising prostate-specific antigen (PSA), local recurrence, metastasis, and survival as endpoints.
Familiar prostate cancer was present in 148 of 1164 men (13%). Men with familial disease were slightly but significantly younger (mean 66 years) at diagnosis than those with sporadic disease (mean 68 years) (p = 0.02). Apart from this there were no significant differences between the two groups in T-stage, Gleason score, pretreatment PSA levels, DNA ploidy, or serum testosterone levels. There were no significant differences in treatment parameters including radiation dose and the use of adjuvant androgen ablation. With a median follow-up of 42 months, there was no difference in freedom from relapse or rising PSA at 6 years between those with a family history (54%) and those without a family history (58%) (p = 0.171). Likewise there was no difference between the two groups when local recurrence or metastasis was the endpoint. Multiple subgroup analyses (younger and older; T1/T2 and T3; low Gleason and high Gleason; no androgen ablation and androgen ablation; race) failed to reveal any differences in outcome in any category between familial and sporadic disease. Among patients with a rising post-treatment PSA profile, PSA doubling times were similar in those with sporadic and familial disease.
This study provides no evidence for any substantial difference between familial and sporadic prostate cancer either in clinicopathological features, in response to treatment, or in ultimate outcome.
比较局限性前列腺癌患者接受根治性外照射放疗后，家族性前列腺癌与散发性前列腺癌的治疗结果。
1987年至1996年间，1214例临床局限性前列腺癌（T1-T4，N0/NX，M0）患者在我科接受了根治性放疗。通过回顾病历并询问患者，在1164例男性患者中获得了关于一级亲属中有无前列腺癌的记录。以复发或前列腺特异性抗原（PSA）升高、局部复发、转移和生存为终点，对这些病例进行单因素和多因素分析。
1164例男性患者中有148例（13%）患有家族性前列腺癌。家族性前列腺癌患者诊断时的年龄（平均66岁）略低于散发性前列腺癌患者（平均68岁），差异有统计学意义（p = 0.02）。除此之外，两组在T分期、Gleason评分、治疗前PSA水平、DNA倍体或血清睾酮水平方面无显著差异。在治疗参数方面，包括放疗剂量和辅助雄激素剥夺治疗的使用，两组之间也没有显著差异。中位随访42个月，有家族史的患者（54%）和无家族史的患者（58%）在6年时无复发或PSA升高的比例无差异（p = 0.171）。同样，以局部复发或转移为终点时，两组之间也没有差异。多项亚组分析（年龄较小和较大；T1/T2和T3；低Gleason评分和高Gleason评分；未进行雄激素剥夺治疗和进行雄激素剥夺治疗；种族）未能揭示家族性和散发性疾病在任何类别中的治疗结果有任何差异。在治疗后PSA水平升高的患者中，散发性和家族性疾病患者的PSA倍增时间相似。
本研究没有提供证据表明家族性前列腺癌与散发性前列腺癌在临床病理特征、对治疗的反应或最终治疗结果方面存在任何实质性差异。
