Rodrigues Neesha A, Chen Ming-Hui, Catalona William J, Roehl Kimberly A, Richie Jerome P, D'Amico Anthony V
Harvard Radiation Oncology Program, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA.
Cancer. 2006 Aug 1;107(3):514-20. doi: 10.1002/cncr.22018.
The authors identified biochemical and pathologic factors that were associated significantly with prostate cancer-specific mortality (PCSM) after androgen deprivation therapy (ADT) in men who had rapidly rising prostate-specific antigen (PSA) levels after they received local treatment.
The study population consisted of 67 patients who had a PSA doubling time (DT) < or =6 months after radical prostatectomy (n = 50 patients) or external beam radiation therapy (n = 17 patients) for localized prostate cancer. Multivariate Cox proportional hazards regression analysis was used to evaluate whether the interval to PSA failure, pre-ADT PSA DT, PSA level at the time of ADT initiation, time to PSA nadir, PSA nadir after 8 months on ADT, and Gleason score were associated significantly with the time to PCSM 8 months after the initiation of ADT.
: A PSA nadir >0.2 ng/mL (adjusted hazard ratio [HR], 8.0; 95% confidence interval [95% CI], 1.7-38.7; P = 0.009) and a Gleason score > or =8 (adjusted HR, 5.2; 95% CI, 1.3-20.6; P = 0.02) were associated significantly with a short time to PCSM. The cumulative incidence estimates of 3-year PCSM were 5.8% versus 50.9% for patients with a PSA nadir < or =0.2 ng/mL versus >0.2 ng/mL, respectively, and 10.8% versus 35.8% for patients who had tumors with a Gleason score < or =7 versus > or =8, respectively.
: Among men with a PSA DT < or =6 months, both a PSA nadir >0.2 ng/mL after ADT and a Gleason score > or =8 cancer identified men who were at high risk for PCSM. These men would be ideal candidates for Phase III studies that evaluate the impact on survival of new systemic therapies for prostate cancer.
作者确定了在接受局部治疗后前列腺特异性抗原（PSA）水平迅速上升的男性中，与雄激素剥夺治疗（ADT）后前列腺癌特异性死亡率（PCSM）显著相关的生化和病理因素。
研究人群包括67例因局限性前列腺癌接受根治性前列腺切除术（n = 50例）或外照射放疗（n = 17例）后PSA倍增时间（DT）≤6个月的患者。采用多变量Cox比例风险回归分析来评估PSA失败间隔、ADT前PSA DT、开始ADT时的PSA水平、PSA最低点时间、ADT 8个月后的PSA最低点以及Gleason评分是否与开始ADT 8个月后的PCSM时间显著相关。
ADT后PSA最低点>0.2 ng/mL（调整后风险比[HR]，8.0；95%置信区间[95%CI]，1.7 - 38.7；P = 0.009）和Gleason评分≥8（调整后HR，5.2；95%CI，1.3 - 20.6；P = 0.02）与较短的PCSM时间显著相关。PSA最低点≤0.2 ng/mL与>0.2 ng/mL的患者3年PCSM的累积发生率估计分别为5.8%和50.9%，Gleason评分≤7与≥8的肿瘤患者分别为10.8%和35.8%。
在PSA DT≤6个月的男性中，ADT后PSA最低点>0.2 ng/mL和Gleason评分≥8的癌症患者被确定为PCSM高风险人群。这些男性将是评估前列腺癌新的全身治疗对生存影响的III期研究的理想候选者。
