Peyromaure Michaël, Allouch Mazen, Eschwege François, Verpillat Patrice, Debré Bernard, Zerbib Marc
Department of Urology, Cochin Hospital, Paris, France.
Urology. 2003 Sep;62(3):503-7. doi: 10.1016/s0090-4295(03)00468-0.
To determine the predictive factors of prostate-specific antigen (PSA) recurrence after salvage radiotherapy (RT) for biochemical recurrence following radical prostatectomy (RP) to identify patients who may benefit from this treatment.
From June 1992 to January 2002, 62 patients experiencing PSA recurrence after RP were treated with RT at a dose of 65 Gy. No patient received hormonal therapy. PSA recurrence after RT was defined as three consecutive increased PSA measurements. The risk of experiencing PSA recurrence after RT was analyzed according to 10 factors: patient age, pre-RP PSA level, pathologic stage, Gleason score, surgical margin status, PSA nadir after RP, time to PSA recurrence after RP, pre-RT PSA level, PSA nadir after RT, and length of follow-up after RT.
With a mean follow-up of 44 months (range 3 to 110), 23 patients (37.1%) experienced PSA recurrence after RT. Using univariate analysis, six factors were found to be predictive of PSA recurrence after RT: the length of follow-up after RT (P <0.0001), PSA nadir after RP (P = 0.0004), time to PSA recurrence after RP (P = 0.003), pre-RP PSA level (P = 0.008), Gleason score (P = 0.011), and pre-RT PSA level (P = 0.028). Using multivariate analysis, only the Gleason score (P = 0.015) and length of follow-up after RT (P = 0.02) were found to be predictive of PSA recurrence after RT. A Gleason score greater than 7 was a significant predictor of PSA recurrence after salvage RT (P = 0.04).
In our experience, the Gleason score and length of follow-up were the sole independent predictors of PSA recurrence after salvage RT. Our findings suggest that patients with a Gleason score of 7 or less are more likely to benefit from salvage RT after RP and that the durability of the PSA response may be only transient.
确定根治性前列腺切除术后生化复发接受挽救性放疗（RT）后前列腺特异性抗原（PSA）复发的预测因素，以识别可能从该治疗中获益的患者。
1992年6月至2002年1月，62例根治性前列腺切除术后出现PSA复发的患者接受了65 Gy剂量的RT治疗。无患者接受激素治疗。RT后PSA复发定义为连续三次PSA测量值升高。根据10个因素分析RT后PSA复发的风险：患者年龄、根治性前列腺切除术前PSA水平、病理分期、Gleason评分、手术切缘状态、根治性前列腺切除术后PSA最低点、根治性前列腺切除术后至PSA复发的时间、RT前PSA水平、RT后PSA最低点以及RT后的随访时间。
平均随访44个月（范围3至110个月），23例患者（37.1%）RT后出现PSA复发。单因素分析发现，六个因素可预测RT后PSA复发：RT后的随访时间（P<0.0001）、根治性前列腺切除术后PSA最低点（P = 0.0004）、根治性前列腺切除术后至PSA复发的时间（P = 0.003）、根治性前列腺切除术前PSA水平（P = 0.008）、Gleason评分（P = 0.011）以及RT前PSA水平（P = 0.028）。多因素分析发现，只有Gleason评分（P = 0.015）和RT后的随访时间（P = 0.02）可预测RT后PSA复发。Gleason评分大于7是挽救性RT后PSA复发的显著预测因素（P = 0.04）。
根据我们的经验，Gleason评分和随访时间是挽救性RT后PSA复发的唯一独立预测因素。我们的研究结果表明，Gleason评分为7或更低的患者在根治性前列腺切除术后更有可能从挽救性RT中获益，且PSA反应的持久性可能只是短暂的。
