Nguyen Paul L, Whittington Richard, Koo Sophia, Schultz Delray, Cote Kerri B, Loffredo Marian, McMahon Elizabeth, Renshaw Andrew A, Tomaszewski John E, D'Amico Anthony V
Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA.
Cancer. 2005 May 15;103(10):2053-9. doi: 10.1002/cncr.21050.
To determine whether a delay in initiating external beam radiation therapy (RT) following diagnosis could impact prostate-specific antigen (PSA) outcome for patients with localized prostate cancer, 460 patients, who received 3D conformal RT to a median dose of 70.4 Gy for clinically localized prostate cancer between 1992 and 2001, were studied.
The primary endpoint was PSA failure (American Society for Therapeutic Radiology and Oncology definition). Estimates of PSA control were made using the Kaplan-Meier method. Delay was defined as the time between diagnosis and the start of RT. Risk groups were defined based on known predictors of PSA outcome, namely, baseline PSA level, clinical T-category, Gleason score, and percentage of biopsy cores positive for tumor. Cox multivariate regression analysis was used to determine the ability of treatment delay to predict time to PSA failure after adjusting for the other known predictors.
Treatment delay independently predicted time to PSA failure following diagnosis for high-risk (Adjusted Hazard Ratio = 1.08 per month; P = 0.029) but not low-risk patients (P = 0.31). Patients with high-risk disease (n = 240) had 5-year estimates of PSA failure-free survival of 55% versus 39% (Plog-rank = 0.014) for those with delay < 2.5 months versus > or = 2.5 months respectively. The median delay was 2.5 months.
Treatment delay adversely affected PSA outcome for high-risk patients but not for low-risk patients following RT.
为了确定诊断后开始进行外照射放疗（RT）的延迟是否会影响局限性前列腺癌患者的前列腺特异性抗原（PSA）结果，我们对1992年至2001年间接受三维适形放疗、临床局限性前列腺癌中位剂量为70.4 Gy的460例患者进行了研究。
主要终点是PSA失败（美国放射肿瘤学会定义）。使用Kaplan-Meier方法对PSA控制情况进行估计。延迟定义为诊断与放疗开始之间的时间。根据已知的PSA结果预测因素，即基线PSA水平、临床T分期、Gleason评分以及肿瘤活检阳性芯的百分比，定义风险组。在对其他已知预测因素进行调整后，使用Cox多变量回归分析来确定治疗延迟预测PSA失败时间的能力。
治疗延迟独立预测高危患者（校正风险比 = 每月1.08；P = 0.029）而非低危患者诊断后至PSA失败的时间（P = 0.31）。高危疾病患者（n = 240）中，延迟<2.5个月与≥2.5个月的患者，5年无PSA失败生存率估计分别为55%和39%（对数秩检验P = 0.014）。中位延迟为2.5个月。
放疗后，治疗延迟对高危患者的PSA结果有不利影响，但对低危患者没有。
