Jhaveri F M, Zippe C D, Klein E A, Kupelian P A
Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
Urology. 1999 Nov;54(5):884-90. doi: 10.1016/s0090-4295(99)00252-6.
To compare rates of overall survival in men with biochemical failure (bF) to those with no bF after radical prostatectomy for localized prostate cancer.
Radical prostatectomy was performed in 1132 consecutive patients between June 1986 and September 1998, and bF (prostate-specific antigen [PSA] 0.2 ng/mL or greater) was documented in 213 patients (19%), with a mean follow-up of 56 months (range 1 to 125). Ninety-nine patients were treated with androgen ablation and/or radiation therapy at the time of bF. Kaplan-Meier estimates of bF, metastasis-free survival, and overall survival were generated and compared using the log-rank test.
The 10-year overall survival rates for patients with bF (88%) versus no bF (93%) were similar (P = 0.94). The survival rates of patients with bF were not statistically different than those of patients without bF when compared by age older than 65 years, preoperative PSA greater than 10 ng/mL, biopsy or specimen Gleason score 7 or greater, clinical Stage T2b-3, presence of extracapsular extension, positive surgical margins, and seminal vesicle invasion. Patients who received second-line treatment also had a similar 10-year overall survival rate (86%, P = 0.97). For the 213 patients with bF, the metastasis-free survival rate at 10 years was 74%. The overall survival rate for patients with distant metastasis (56%) was markedly lower (P <0.001) than for those without distant metastasis.
At 10 years, patients with a PSA recurrence after radical prostatectomy for localized disease have an excellent overall survival equivalent to those without a detectable PSA. Within this period, the clinical significance of a detectable PSA needs to be further evaluated.
比较局限性前列腺癌根治性前列腺切除术后发生生化复发（bF）的男性与未发生生化复发的男性的总生存率。
1986年6月至1998年9月期间，对1132例连续患者实施了根治性前列腺切除术，其中213例患者（19%）出现生化复发（前列腺特异性抗原[PSA]≥0.2 ng/mL），平均随访56个月（范围1至125个月）。99例患者在生化复发时接受了雄激素剥夺和/或放射治疗。采用Kaplan-Meier法估计生化复发、无转移生存率和总生存率，并使用对数秩检验进行比较。
发生生化复发的患者10年总生存率为88%，未发生生化复发的患者为93%，二者相似（P = 0.94）。按年龄大于65岁、术前PSA大于10 ng/mL、活检或标本Gleason评分7分或更高、临床分期T2b-3、存在包膜外侵犯、手术切缘阳性和精囊侵犯进行比较时，发生生化复发的患者生存率与未发生生化复发的患者无统计学差异。接受二线治疗的患者10年总生存率也相似（86%，P = = 0.97）。对于213例发生生化复发的患者，10年无转移生存率为74%。远处转移患者的总生存率（56%）明显低于无远处转移患者（P < 0.001）。
局限性疾病根治性前列腺切除术后PSA复发的患者10年总生存率良好，与未检测到PSA的患者相当。在此期间，可检测到的PSA的临床意义需要进一步评估。
