Merrick Gregory S, Butler Wayne M, Wallner Kent E, Galbreath Robert W, Allen Zachariah A, Adamovich Edward
Schiffler Cancer Center, USA.
Urology. 2005 Nov;66(5):1048-53. doi: 10.1016/j.urology.2005.05.024.
To evaluate the influence of perineural invasion (PNI) in the biopsy specimen on biochemical progression-free survival in hormone-naive patients with prostate cancer undergoing brachytherapy.
A total of 512 consecutive hormone-naive patients (173 low risk, 212 intermediate risk, and 127 high risk) underwent brachytherapy for clinical Stage T1b-T2cNxM0 (2002 American Joint Committee on Cancer staging system) prostate cancer. No patient underwent seminal vesicle or pathologic lymph node staging. All patients had undergone brachytherapy at least 3 years before analysis. The median follow-up was 5.3 years. Biochemical progression-free survival was defined by a prostate-specific antigen (PSA) cutpoint of 0.4 ng/mL or less after nadir and by the American Society for Therapeutic Radiology and Oncology consensus definition. PNI was defined as carcinoma tracking along, or around, a nerve within the perineural space.
PNI was documented in 133 patients (26.0%). For both biochemical progression-free definitions, 94.0% and 94.9% of patients with and without PNI, respectively, remained free of biochemical progression. The median time to failure in patients with and without PNI was 17.2 and 17.9 months, respectively. For the biochemically disease-free cohort, the median posttreatment PSA level was less than 0.1 ng/mL. On univariate Cox regression analysis, the pretreatment PSA level, percentage of positive biopsies, prostate volume, and Gleason score predicted for biochemical outcome. PNI did not approach statistical significance (P = 0.671). On multivariate analysis, only pretreatment PSA (P < 0.001) and the percentage of positive biopsies (P < 0.001) maintained statistical significance.
In hormone-naive brachytherapy patients implanted with generous periprostatic treatment margins, the presence of PNI in the biopsy specimen did not adversely affect 8-year biochemical progression-free survival.
评估活检标本中神经周围浸润（PNI）对接受近距离放射治疗的激素初治前列腺癌患者生化无进展生存期的影响。
共有512例连续的激素初治患者（173例低危、212例中危和127例高危）因临床分期为T1b - T2cNxM0（2002年美国癌症联合委员会分期系统）的前列腺癌接受近距离放射治疗。无患者接受精囊或病理淋巴结分期。所有患者在分析前至少已接受近距离放射治疗3年。中位随访时间为5.3年。生化无进展生存期的定义为最低点后前列腺特异性抗原（PSA）切点为0.4 ng/mL或更低，以及依据美国放射肿瘤学会的共识定义。PNI定义为癌组织沿神经周围间隙内的神经或在其周围蔓延。
133例患者（26.0%）记录有PNI。对于两种生化无进展生存期的定义，有和无PNI的患者分别有94.0%和94.9%未出现生化进展。有和无PNI患者的中位失败时间分别为17.2个月和17.9个月。对于生化无病队列，治疗后中位PSA水平低于0.1 ng/mL。单因素Cox回归分析显示，治疗前PSA水平、阳性活检百分比、前列腺体积和Gleason评分可预测生化结果。PNI未达到统计学意义（P = 0.671）。多因素分析显示，只有治疗前PSA（P < 0.001）和阳性活检百分比（P < 0.001）保持统计学意义。
在植入较大前列腺周围治疗边界的激素初治近距离放射治疗患者中，活检标本中PNI的存在对8年生化无进展生存期无不利影响。
