Freedland Stephen J, Humphreys Elizabeth B, Mangold Leslie A, Eisenberger Mario, Partin Alan W
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA.
J Urol. 2006 Oct;176(4 Pt 1):1404-8. doi: 10.1016/j.juro.2006.06.017.
In patients treated with radical prostatectomy who have biochemical recurrence we have previously reported that time from surgery to biochemical recurrence and postoperative prostate specific antigen doubling time are significantly related to the risk of prostate cancer death. We performed a more thorough examination of the association of time from surgery to biochemical recurrence and the risk of prostate cancer death.
We retrospectively studied the records of 379 patients treated with radical prostatectomy between 1982 and 2000 who had had biochemical recurrence. We examined the association of time from surgery to prostate specific antigen recurrence and prostate specific antigen doubling time, and the risk of prostate cancer death using the Spearman correlation and Cox proportional hazards regression, respectively.
Longer time from surgery to prostate specific antigen recurrence was associated with a slower prostate specific antigen doubling time (Spearman r = 0.36, p < 0.001) and a decreased risk of prostate cancer death (RR 0.76, 95% CI 0.66 to 0.88, p < 0.001). The 15-year actuarial prostate cancer specific survival rate after biochemical recurrence in patients with recurrence at 3 years or less was 41% (95% CI 29 to 53) compared to 87% (95% CI 75 to 93) in patients with recurrence more than 3 years after radical prostatectomy. On multivariate analysis a shorter time from surgery to prostate specific antigen recurrence was associated with an increased risk of prostate cancer death (3 or less vs more than 3 years, RR 2.70, 95% CI 1.37 to 5.31, p = 0.004).
Earlier prostate specific antigen recurrence is associated with an increased risk of prostate cancer death. These data suggest that perhaps time to prostate specific antigen recurrence may be a reasonable intermediate end point in patients treated with radical prostatectomy, although this must be validated in other studies.
在接受根治性前列腺切除术且出现生化复发的患者中，我们之前报告过从手术到生化复发的时间以及术后前列腺特异性抗原倍增时间与前列腺癌死亡风险显著相关。我们对从手术到生化复发的时间与前列腺癌死亡风险之间的关联进行了更全面的研究。
我们回顾性研究了1982年至2000年间379例接受根治性前列腺切除术且出现生化复发患者的记录。我们分别使用Spearman相关性分析和Cox比例风险回归分析，研究了从手术到前列腺特异性抗原复发的时间、前列腺特异性抗原倍增时间与前列腺癌死亡风险之间的关联。
从手术到前列腺特异性抗原复发的时间越长，前列腺特异性抗原倍增时间越慢（Spearman相关系数r = 0.36，p < 0.001），前列腺癌死亡风险越低（风险比RR = 0.76，95%置信区间CI为0.66至0.88，p < 0.001）。根治性前列腺切除术后3年及以内复发的患者，生化复发后15年的精算前列腺癌特异性生存率为41%（95%CI为29%至53%），而复发时间超过3年的患者这一比例为87%（95%CI为75%至93%）。多因素分析显示，从手术到前列腺特异性抗原复发的时间越短，前列腺癌死亡风险越高（3年及以内与超过3年相比，RR = 2.70，95%CI为1.37至5.31，p = 0.004）。
前列腺特异性抗原较早复发与前列腺癌死亡风险增加相关。这些数据表明，对于接受根治性前列腺切除术的患者，前列腺特异性抗原复发时间可能是一个合理的中间终点，尽管这一点必须在其他研究中得到验证。
