Pollack Alan, Hanlon Alexandra L, Horwitz Eric M, Feigenberg Steven J, Uzzo Robert G, Hanks Gerald E
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111-2497, USA.
J Urol. 2004 Mar;171(3):1132-6. doi: 10.1097/01.ju.0000111844.95024.74.
The effectiveness of increasing radiotherapy dose for men with prostate cancer was evaluated with reference to prognostic groups as defined by pretreatment serum prostate specific antigen (PSA), Gleason score, T stage and perineural invasion.
There were 839 men treated between April 1989 and December 1997 with conformal radiotherapy alone. Cox multivariate analysis was used to establish important predictors of biochemical failure (BF) separately for patients with an initial pretreatment PSA (iPSA) of less than 10, 10 to 19.9, or 20 or greater ng/ml. Radiotherapy (RT) dose was evaluated as a continuous and categorical (dose groups of less than 72, 72 to 75.9 and 76 Gy or greater) variable.
At a median 63-month followup multivariate analysis demonstrated that iPSA and radiotherapy (RP) dose were the most significant predictors of BF, followed by Gleason score and T stage. Perineural invasion was not an independent correlate of outcome. RT dose was significant in all iPSA groups (less than 10, 10 to 19.9 and 20 or greater ng/ml). Gleason score was significant when iPSA was less than 10 ng/ml. T stage was significant when iPSA was 20 ng/ml or greater and it was borderline when iPSA was 10 to 19.9 ng/ml (p = 0.08). Prognostic subgroups were derived from these results and tested for an effect of RT dose on univariate analysis. Radiation dose was not a correlate of BF in the most favorable (PSA less than 10 ng/ml and Gleason score 2 to 6) and the most unfavorable (PSA 20 ng/ml or greater and stage T3-T4) prognostic groups but it was otherwise an influential determinant of outcome.
RT dose escalation to 76 Gy or greater improved patient outcome for all prognostic groups except those at the favorable and unfavorable extremes.
参照治疗前血清前列腺特异性抗原（PSA）、Gleason评分、T分期和神经周围浸润所定义的预后分组，评估增加前列腺癌男性患者放疗剂量的有效性。
1989年4月至1997年12月期间，共有839名男性仅接受适形放疗。采用Cox多变量分析分别确定初始治疗前PSA（iPSA）小于10、10至19.9或20 ng/ml及以上患者生化失败（BF）的重要预测因素。放疗（RT）剂量作为连续变量和分类变量（剂量组小于72、72至75.9及76 Gy及以上）进行评估。
在中位63个月的随访中，多变量分析表明iPSA和放疗（RP）剂量是BF的最显著预测因素，其次是Gleason评分和T分期。神经周围浸润不是结局的独立相关因素。RT剂量在所有iPSA组（小于10、10至19.9及大于等于20 ng/ml）中均具有显著性。当iPSA小于10 ng/ml时，Gleason评分具有显著性。当iPSA为20 ng/ml及以上时，T分期具有显著性，而当iPSA为10至19.9 ng/ml时，T分期处于临界状态（p = 0.08）。根据这些结果得出预后亚组，并在单变量分析中测试RT剂量的影响。在最有利（PSA小于10 ng/ml且Gleason评分为2至6）和最不利（PSA为20 ng/ml及以上且分期为T3 - T4）的预后组中，放射剂量与BF无关，但在其他情况下，它是结局的一个有影响的决定因素。
将RT剂量增至76 Gy及以上可改善除最有利和最不利极端情况外的所有预后组患者的结局。
