Kestin Larry L, Vicini Frank A, Martinez Alvaro A
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA.
Int J Radiat Oncol Biol Phys. 2004 Oct 1;60(2):453-62. doi: 10.1016/j.ijrobp.2004.03.013.
We analyzed our experience treating localized prostate cancer to determine the impact of androgen deprivation (AD) on clinical outcome if administered at the time of isolated biochemical failure (BF) vs. after clinical failure (clinical failure), and the associated impact of various BF definitions.
A total of 1,201 patients with stage T1-T3N0M0 prostate cancer were treated with external beam radiotherapy (EBRT) to a median dose of 66.6 Gy. Early AD was defined as administration of AD after BF, without evidence of clinical failure. Delayed AD was defined as administration of AD after clinical failure. Multiple BF definitions were tested for capacity to predict subsequent clinical failure. For each BF definition, outcome was compared for BF patients receiving early AD vs. no or delayed AD.
Five-year clinical failure (from date of BF) was 60% for patients who experienced a prostate-specific antigen rise to >/=3 ng/mL above nadir. For these patients, early AD was associated with decreased 5-year local failure (4% vs. 33%), distant metastasis (13% vs. 44%), cause-specific death (9% vs. 24%), and death due to any cause (32% vs. 48%), despite poorer prognostic factors in patients receiving early AD. On multivariate analysis, early AD remained independently significant for each of these end points.
The efficacy of AD after BF varies depending on the BF definition. When an optimal BF definition is applied, early AD decreases distant metastasis and improves survival. Prostate-specific antigen elevation to >/=2 or >/=3 ng/mL above nadir seems optimal in establishing clinically significant BF and the timing of AD intervention.
我们分析了治疗局限性前列腺癌的经验，以确定雄激素剥夺（AD）在孤立性生化失败（BF）时与临床失败后给药对临床结局的影响，以及各种BF定义的相关影响。
共有1201例T1-T3N0M0期前列腺癌患者接受了外照射放疗（EBRT），中位剂量为66.6 Gy。早期AD定义为在BF后给予AD，且无临床失败证据。延迟AD定义为在临床失败后给予AD。测试了多种BF定义预测后续临床失败的能力。对于每种BF定义，比较了接受早期AD与未接受或延迟接受AD的BF患者的结局。
前列腺特异性抗原升高至高于最低点≥3 ng/mL的患者，5年临床失败率（自BF之日起）为60%。对于这些患者，早期AD与5年局部失败率降低（4%对33%）、远处转移率降低（13%对44%）、病因特异性死亡率降低（9%对24%）以及任何原因导致的死亡率降低（32%对48%）相关，尽管接受早期AD的患者预后因素较差。多因素分析显示，早期AD对这些终点中的每一个仍具有独立的显著性。
BF后AD的疗效因BF定义而异。应用最佳BF定义时，早期AD可降低远处转移并提高生存率。前列腺特异性抗原升高至高于最低点≥2或≥3 ng/mL似乎是确定具有临床意义的BF和AD干预时机的最佳方法。
