Ludgate Charles M, Bishop Darcy C, Pai Howard, Eldridge Brenna, Lim Jan, Berthelet Eric, Blood Paul, Piercy G Bruce, Steinhoff Gary
Radiation Therapy Program, B.C. Cancer Agency--Vancouver Island Centre, Victoria, BC, Canada.
Int J Radiat Oncol Biol Phys. 2005 Aug 1;62(5):1309-15. doi: 10.1016/j.ijrobp.2005.01.001.
To examine the impact of various patient, disease, and treatment characteristics on outcome in patients treated with neoadjuvant hormone therapy (NAHT) and external-beam radiation therapy (EBRT) for clinically localized, high-risk prostate adenocarcinoma (initial prostate-specific antigen [PSA] level >20, Gleason score 8-10 or Stage > or = T3).
A retrospective chart review was conducted on 407 patients treated between 1991 and 2001 with NAHT and EBRT for high-risk prostate cancer. The effect of tumor (PSA level, Gleason score, and T stage) and treatment (NAHT duration, total-hormone duration, preradiation PSA) characteristics on rates of biochemical disease-free survival (bDFS), prostate cancer-specific survival, and overall survival were examined.
Median follow-up time was 78 months (range: 5-140 months). Actuarial bDFS at 5 years was 52% (95% confidence interval [CI], 46% to 57%) for the entire group. On multivariate analysis, initial PSA level (p = 0.004), Gleason score (p = 0.005), and preradiation PSA level (p < 0.001) were predictive of bDFS, whereas age, T stage, duration of NAHT, and duration of total hormone therapy were not predictive of outcomes. Gleason score and preradiation PSA level were also predictive of prostate cancer-specific survival rates.
Improved bDFS in patients with high-risk prostate cancer was associated with lower initial PSA level, lower Gleason score, and lower preradiation PSA level. The duration of NAHT did not have an impact on outcomes, but the preradiation PSA was an important predictor of bDFS in high-risk patients.
探讨各种患者、疾病及治疗特征对接受新辅助激素治疗（NAHT）和外照射放疗（EBRT）的临床局限性高危前列腺腺癌患者（初始前列腺特异性抗原[PSA]水平>20、 Gleason评分8 - 10或分期≥T3）预后的影响。
对1991年至2001年间接受NAHT和EBRT治疗的407例高危前列腺癌患者进行回顾性病历审查。研究肿瘤（PSA水平、Gleason评分和T分期）及治疗（NAHT持续时间、总激素治疗持续时间、放疗前PSA）特征对无生化复发生存率（bDFS）、前列腺癌特异性生存率和总生存率的影响。
中位随访时间为78个月（范围：5 - 140个月）。整个组5年的精算bDFS为52%（95%置信区间[CI]，46%至57%）。多因素分析显示，初始PSA水平（p = 0.004）、Gleason评分（p = 0.005）和放疗前PSA水平（p < 0.001）可预测bDFS，而年龄、T分期、NAHT持续时间和总激素治疗持续时间不能预测预后。Gleason评分和放疗前PSA水平也可预测前列腺癌特异性生存率。
高危前列腺癌患者bDFS的改善与较低的初始PSA水平、较低的Gleason评分和较低的放疗前PSA水平相关。NAHT的持续时间对预后无影响，但放疗前PSA是高危患者bDFS的重要预测指标。
