Chism Derek B, Hanlon Alexandra L, Horwitz Eric M, Feigenberg Steven J, Pollack Alan
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111-2497, USA.
Int J Radiat Oncol Biol Phys. 2004 Jun 1;59(2):380-5. doi: 10.1016/j.ijrobp.2003.10.059.
Two models for stratification of prostate cancer aggressiveness predominate for the purposes of daily treatment decision making. This study investigates the relationships between these two clinically popular models.
Both risk stratification models use the same definition for low risk: Gleason score (GS) <or=6, pretreatment initial prostate specific antigen (iPSA) <or=10 ng/mL, and stage T1c-T2c. For the single factor high risk model (SF), intermediate risk (IR) is defined as the presence of GS 7 or PSA > 10-20 ng/mL, without the presence of any high-risk feature; high risk (HR) was defined as the presence of GS 8-10, iPSA >20, or palpation stage T3. For the double factor high risk (DF) model, IR and HR were defined as one and more than one of the following: GS >or=7, iPSA >10, or stage T3. Between April 1989 and October 2001, 1,597 patients were treated definitively with 3D conformal radiation therapy (3D-CRT) alone for prostate cancer at our institution. The main clinical endpoint was freedom from biochemical failure (FFBF).
The 5-year actuarial FFBF rate for the low-risk group was 83%. The SF model resulted in FFBF rates of 76% and 47% for IR and HR patients respectively. The DF model resulted in FFBF rates of 70% and 52% for IR and HR patients, respectively. The FFBF rate for patients defined as IR and HR by both models was 76% and 40%, respectively. Those classified as IR by the DF model and then further subdivided into IR and HR by the SF model had a 76% and 52% 5-year FFBF rate (p = 0.0004). Those classified as HR by the DF model and then further subdivided into IR and HR by the SF model had a 71% and 40% 5-year FFBF (p = 0.0014).
The SF model created prognostic groups with a greater internal consistency than the DF model. The SF was also better at identifying patients with high-risk prostate cancer who may benefit from a more aggressive approach.
在日常治疗决策中，有两种前列腺癌侵袭性分层模型占主导地位。本研究调查这两种临床常用模型之间的关系。
两种风险分层模型对低风险的定义相同： Gleason评分（GS）≤6，治疗前初始前列腺特异性抗原（iPSA）≤10 ng/mL，以及T1c-T2c期。对于单因素高风险模型（SF），中度风险（IR）定义为存在GS 7或PSA>10-20 ng/mL，且不存在任何高风险特征；高风险（HR）定义为存在GS 8-10、iPSA>20或触诊分期为T3。在1989年4月至2001年10月期间，我院1597例前列腺癌患者仅接受了三维适形放疗（3D-CRT）根治性治疗。主要临床终点是无生化失败（FFBF）。
低风险组的5年精算FFBF率为83%。SF模型中，IR和HR患者的FFBF率分别为76%和47%。DF模型中，IR和HR患者的FFBF率分别为70%和52%。两种模型均定义为IR和HR的患者的FFBF率分别为76%和40%。那些被DF模型分类为IR，然后被SF模型进一步细分为IR和HR的患者，其5年FFBF率分别为76%和52%（p = 0.0004）。那些被DF模型分类为HR，然后被SF模型进一步细分为IR和HR的患者，其5年FFBF率分别为71%和40%（p = 0.0014）。
与DF模型相比，SF模型创建的预后组具有更高的内部一致性。SF模型在识别可能从更积极治疗方法中获益的高危前列腺癌患者方面也表现更好。
