Sylvester J, Blasko J C, Grimm P D, Meier R, Cavanagh W
Seattle Prostate Institute, Seattle, Washington, USA.
Mol Urol. 2000 Fall;4(3):155-9;discussion 161.
In order to evaluate the effect of short-term androgen blockade on biochemical control rates for high-risk patients receiving a combination regimen of external-beam radiation therapy and low-dose-rate permanent seed implant brachytherapy, a retrospective matched subset analysis was performed.
Inclusion in the high-risk cohort required at least two of the following poor prognostic factors: serum prostate specific antigen (PSA) concentration > or = 10.0 ng/mL, Gleason score > or = 7, or clinical stage T(2c) or T(3a) disease. Twenty-one patients who underwent androgen ablation between June 1991 and December 1995 in addition to combined-modality radiation therapy qualified as high risk, as did 77 patients who underwent combined-radiation therapy only. There was no statistically significant difference between the two groups in terms of follow-up (mean 44.6 v 47.8 months, respectively), pretreatment PSA, clinical stage, biopsy Gleason score, or the presence of all three poor prognostic factors.
The overall rates of freedom from biochemical failure at 5 years were 77% in the hormonally treated group and 58% in the nonhormonally treated group. The difference was not statistically significant by log rank test (P = 0.08).
Longer follow-up with larger patient numbers is needed to define the role of adjuvant androgen ablation combined with radiation therapy.
为了评估短期雄激素阻断对接受外照射放疗与低剂量率永久性粒子植入近距离放疗联合方案的高危患者生化控制率的影响，进行了一项回顾性配对亚组分析。
纳入高危队列要求至少具备以下两个不良预后因素：血清前列腺特异性抗原（PSA）浓度≥10.0 ng/mL、Gleason评分≥7或临床分期为T(2c)或T(3a)期疾病。1991年6月至1995年12月期间除接受联合放疗外还接受雄激素去除治疗的21例患者符合高危标准，仅接受联合放疗的77例患者也符合高危标准。两组在随访时间（分别为平均44.6个月和47.8个月）、治疗前PSA、临床分期、活检Gleason评分或所有三个不良预后因素的存在情况方面无统计学显著差异。
激素治疗组5年时无生化失败的总体发生率为77%，非激素治疗组为58%。经对数秩检验，差异无统计学显著性（P = 0.08）。
需要对更多患者进行更长时间的随访，以确定辅助性雄激素去除联合放疗的作用。
