Merrick Gregory S, Butler Wayne M, Wallner Kent E, Galbreath Robert W, Allen Zachariah A, Adamovich Edward
Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV, USA.
Int J Radiat Oncol Biol Phys. 2006 Jul 1;65(3):669-77. doi: 10.1016/j.ijrobp.2006.01.030. Epub 2006 May 6.
To determine if androgen-deprivation therapy (ADT) has an impact on cause-specific, biochemical progression-free, or overall survival after prostate brachytherapy.
From April 1995 through June 2002, 938 consecutive patients underwent brachytherapy for clinical Stage T1b to T3a (2002 AJCC) prostate cancer. All patients underwent brachytherapy more than 3 years before analysis. A total of 382 patients (40.7%) received ADT with a duration of 6 months or less in 277 and more than 6 months in 105. The median follow-up was 5.4 years. Multiple clinical, treatment, and dosimetric parameters were evaluated as predictors of cause-specific, biochemical progression-free, and overall survival.
The 10-year cause-specific, biochemical progression-free, and overall survival rates for the entire cohort were 96.4%, 95.9%, and 78.1%, respectively. Except for biochemical progression-free survival in high-risk patients, ADT did not statistically impact any of the three survival categories. A Cox linear-regression analysis demonstrated that Gleason score was the best predictor of cause-specific survival, whereas percent-positive biopsies, prostate volume, and risk group predicted for biochemical progression-free survival. Patient age and tobacco use were the strongest predictors of overall survival. One hundred two patients have died, with 80 of the deaths a result of cardiovascular disease (54) and second malignancies (26). To date, only 12 patients have died of metastatic prostate cancer.
After brachytherapy, androgen-deprivation therapy did not have an impact on cause-specific or overall survival for any risk group; however, ADT had a beneficial effect on biochemical progression-free survival in high-risk patients. Cardiovascular disease and second malignancies far outweighed prostate cancer as competing causes of death.
确定雄激素剥夺疗法（ADT）对前列腺近距离放射治疗后的特定病因、无生化进展或总生存率是否有影响。
从1995年4月至2002年6月，938例连续患者因临床分期为T1b至T3a（2002年美国癌症联合委员会）的前列腺癌接受近距离放射治疗。所有患者在分析前3年以上接受了近距离放射治疗。共有382例患者（40.7%）接受了ADT，其中277例持续时间为6个月或更短，105例持续时间超过6个月。中位随访时间为5.4年。评估了多个临床、治疗和剂量学参数作为特定病因、无生化进展和总生存率的预测因素。
整个队列的10年特定病因、无生化进展和总生存率分别为96.4%、95.9%和78.1%。除高危患者的无生化进展生存率外，ADT对三种生存类别中的任何一种均无统计学影响。Cox线性回归分析表明，Gleason评分是特定病因生存的最佳预测因素，而活检阳性百分比、前列腺体积和风险组可预测无生化进展生存。患者年龄和吸烟是总生存的最强预测因素。102例患者死亡，其中80例死于心血管疾病（54例）和第二原发恶性肿瘤（26例）。迄今为止，只有12例患者死于转移性前列腺癌。
近距离放射治疗后，雄激素剥夺疗法对任何风险组的特定病因或总生存率均无影响；然而，ADT对高危患者的无生化进展生存有有益影响。心血管疾病和第二原发恶性肿瘤作为竞争死因，远远超过前列腺癌。
