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前列腺癌根治术后长期挽救性放疗的结果及复发预测因素

Long-term salvage radiotherapy outcome after radical prostatectomy and relapse predictors.

作者信息

Brooks Joseph P, Albert Paul S, Wilder Richard B, Gant Dean A, McLeod David G, Poggi Matthew M

机构信息

Section of Radiation Oncology, Department of Urology, Walter Reed Army Medical Center, Washington, D. C., USA.

出版信息

J Urol. 2005 Dec;174(6):2204-8, discussion 2208. doi: 10.1097/01.ju.0000181223.99576.ff.

Abstract

PURPOSE

We assessed the efficacy of salvage radiotherapy (SRT) and analyzed predictors of biochemical progression-free survival (bPFS) and distant metastasis-free survival in patients with clinically localized disease recurrence after radical prostatectomy.

MATERIALS AND METHODS

The records of 114 patients treated with SRT at 2 institutions between 1991 and 2001 were retrospectively reviewed. Time to biochemical recurrence and to distant metastases was analyzed using the Kaplan-Meier estimation. Candidate predictors of bPFS and distant metastasis-free survival were analyzed using the log rank test and Cox regression. Acute and late complications were scored using Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria.

RESULTS

At a median followup of 6.3 years (range 1.9 to 13.3) for SRT 4 and 6-year bPFS was 50% (95% CI 42% to 61%) and 33% (95% CI 24% to 43%), respectively. The 6-year actuarial probability of distant metastases after SRT was 14%. Multivariate analysis demonstrated an independent association of increasing Gleason score, lymphovascular invasion and lack of a complete response to SRT with decreased 5-year bDFS. These factors were associated with significantly less 5-year distant metastasis-free survival. Pre-RT prostate specific antigen greater than 2.0 ng/ml was associated with significantly decreased 5-year bDFS and distant metastasis-free survival, although it was not maintained on multivariate analysis.

CONCLUSIONS

SRT results in durable prostate specific antigen control in select patients. It is well tolerated with few severe late effects. Increasing Gleason score, lymphovascular invasion and lack of a complete response to SRT are significant risks for disease progression requiring additional management.

摘要

目的

我们评估了挽救性放疗(SRT)的疗效,并分析了根治性前列腺切除术后临床局限性疾病复发患者的无生化进展生存期(bPFS)和无远处转移生存期的预测因素。

材料与方法

回顾性分析了1991年至2001年间在2家机构接受SRT治疗的114例患者的记录。采用Kaplan-Meier估计法分析生化复发和远处转移的时间。使用对数秩检验和Cox回归分析bPFS和无远处转移生存期的候选预测因素。根据放射治疗肿瘤学组/欧洲癌症研究与治疗组织标准对急性和晚期并发症进行评分。

结果

SRT的中位随访时间为6.3年(范围1.9至13.3年),4年和6年的bPFS分别为50%(95%CI 42%至61%)和33%(95%CI 24%至43%)。SRT后6年远处转移的精算概率为14%。多变量分析显示,Gleason评分增加、淋巴管侵犯以及对SRT无完全反应与5年bDFS降低独立相关。这些因素与5年无远处转移生存期显著降低相关。放疗前前列腺特异性抗原大于2.0 ng/ml与5年bDFS和无远处转移生存期显著降低相关,尽管在多变量分析中未保持这一相关性。

结论

SRT可使部分患者的前列腺特异性抗原得到持久控制。其耐受性良好,严重的晚期效应较少。Gleason评分增加、淋巴管侵犯以及对SRT无完全反应是疾病进展需要额外治疗的重要风险因素。

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