Vicini Frank A, Martinez Alvaro, Hanks Gerald, Hanlon Alex, Miles Brian, Kernan Ken, Beyers David, Ragde Haakon, Forman Jeffrey, Fontanesi James, Kestin Larry, Kovacs Gyorgy, Denis Louis, Slawin Kevin, Scardino Peter
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA.
Cancer. 2002 Nov 15;95(10):2126-35. doi: 10.1002/cncr.10919.
The optimal management of patients with clinically localized prostate carcinoma remains undefined due in part to the absence of well-designed, prospective, randomized trials. The current study was conducted to compare and contrast outcomes with different forms of therapy for patients with prostate carcinoma who were treated at several institutions using predefined prognostic categories.
A retrospective study of 6877 men with prostate carcinoma who were treated between 1989 and 1998 at 7 different institutions with 6 different types of therapy was conducted. Five-year actuarial rates of prostate specific antigen (PSA) failure were calculated based on predefined prognostic categories, which included combinations of pretreatment PSA level, tumor stage, and Gleason score. In addition, outcome was calculated using consistent biochemical failure definitions and a minimum, median length of follow-up.
Substantial differences in outcome were observed for the same type of treatment and at the same institution, depending on the number of prognostic variables used to define treatment groups. However, estimates of 5-year PSA outcomes after all forms of therapy for low-risk and intermediate-risk patient groups were remarkably similar (regardless of the type of treatment) when all three pretreatment variables were used to define prognostic categories. For patients in high-risk groups, the 5-year PSA outcomes were suboptimal, regardless of the treatment technique used.
The current data suggest that interinstitutional and interspecialty comparisons of treatment outcome for patients with prostate carcinoma are possible but that results must be based on all major prognostic variables to be meaningful. Analyzed in this fashion, 5-year PSA results were similar for patients in low-risk and intermediate-risk groups, regardless of the form of therapy. Findings from prospective, randomized trials using survival (cause specific and overall) as the end point for judging treatment efficacy and longer follow-up will be needed to validate these findings and to identify the most appropriate management option for patients with all stages of disease.
临床局限性前列腺癌患者的最佳治疗方案尚未明确，部分原因是缺乏精心设计的前瞻性随机试验。本研究旨在比较和对比多家机构采用预定义预后分类法对前列腺癌患者进行不同形式治疗的结果。
对1989年至1998年间在7家不同机构接受6种不同类型治疗的6877例前列腺癌男性患者进行回顾性研究。根据预定义的预后分类计算前列腺特异性抗原（PSA）失败的5年精算率，这些分类包括治疗前PSA水平、肿瘤分期和 Gleason评分的组合。此外，使用一致的生化失败定义和最短、中位随访时间计算结果。
在同一机构，相同类型的治疗根据用于定义治疗组的预后变量数量不同，结果存在显著差异。然而，当使用所有三个治疗前变量来定义预后分类时，低风险和中风险患者组在接受所有形式治疗后的5年PSA结果估计非常相似（无论治疗类型如何）。对于高风险组的患者，无论采用何种治疗技术，5年PSA结果都不理想。
目前的数据表明，前列腺癌患者治疗结果的机构间和专业间比较是可行的，但结果必须基于所有主要预后变量才有意义。以这种方式分析，低风险和中风险组患者的5年PSA结果相似，无论治疗形式如何。需要进行以前瞻性随机试验，以生存（特定病因和总体）作为判断治疗疗效的终点，并进行更长时间的随访，以验证这些发现，并为所有疾病阶段的患者确定最合适的管理方案。
