Sengupta Shomik, Blute Michael L, Bagniewski Stephanie M, Myers Robert P, Bergstralh Eric J, Leibovich Bradley C, Zincke Horst
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2006 May;175(5):1684-90; discussion 1690. doi: 10.1016/S0022-5347(05)00978-X.
Adjuvant hormonal therapy may be beneficial in patients who are treated with RRP and found to have adverse pathological findings. We assessed the natural history of detectable PSA in such patients with particular emphasis on the prognostic usefulness of PSADT.
We identified 903 patients treated with RRP and adjuvant hormonal therapy (started less than 90 days postoperatively) for prostate cancer at our institution between 1990 and 1999. PSADT was calculated by log linear regression in men with 2 or more PSA measurements available at least 90 days apart. CSS and sRFS were estimated by the Kaplan-Meier method and analyzed using Cox proportional hazard models.
At a median followup of 9.1 years PSA had become detectable in 369 of 771 patients (47.9%) who achieved an undetectable nadir. PSADT evaluable in 463 patients was less than 12 months in 68 (14.6%) and more than 10 years in 283 (61.1%). N stage and Gleason score were significantly associated with sRFS and CSS. PSADT was a significant predictor of sRFS and CSS in N+ and N0 cases with a cancer death HR of 0.55 (95% CI 0.43 to 0.71) and 0.50 (95% CI 0.31 to 0.79), respectively. The association between PSADT and survival persisted after multivariate adjustment for preoperative PSA, specimen Gleason score and seminal vesicle invasion.
This study demonstrates that many patients have slow progression despite increasing PSA following RRP and adjuvant hormonal therapy. Nodal status, cancer grade and PSADT are predictive of sRFS and CSS, and may be a useful means of selecting patients for future adjuvant therapy trials.
辅助激素治疗对于接受根治性耻骨后前列腺切除术（RRP）且有不良病理结果的患者可能有益。我们评估了此类患者中可检测到的前列腺特异性抗原（PSA）的自然病程，特别强调了PSA倍增时间（PSADT）的预后价值。
我们确定了1990年至1999年间在本机构接受RRP及辅助激素治疗（术后90天内开始）的903例前列腺癌患者。对于间隔至少90天有2次或更多次PSA测量值的男性，通过对数线性回归计算PSADT。累积生存率（CSS）和无远处转移生存率（sRFS）采用Kaplan-Meier法估计，并使用Cox比例风险模型进行分析。
在中位随访9.1年时，771例达到不可检测最低点的患者中有369例（47.9%）PSA变得可检测。463例可评估PSADT的患者中，68例（14.6%）的PSADT小于12个月，283例（61.1%）的PSADT超过10年。N分期和Gleason评分与sRFS和CSS显著相关。在N+和N0病例中，PSADT是sRFS和CSS的显著预测因子，癌症死亡风险比（HR）分别为0.55（95%可信区间[CI] 0.43至0.71）和0.50（95% CI 0.31至0.79）。在对术前PSA、标本Gleason评分和精囊侵犯进行多变量调整后，PSADT与生存率之间的关联仍然存在。
本研究表明，尽管RRP及辅助激素治疗后PSA升高，但许多患者进展缓慢。淋巴结状态、癌症分级和PSADT可预测sRFS和CSS，可能是选择患者进行未来辅助治疗试验的有用方法。
