Semeniuk Ross C, Venner Peter M, North Scott
University of Alberta Faculty of Medicine, Edmonton, Alberta, Canada.
Urology. 2006 Sep;68(3):565-9. doi: 10.1016/j.urology.2006.03.055.
Men with metastatic hormone-refractory prostate cancer (HRPC) form a heterogeneous population with a wide range of symptoms and variable survival. Patient selection is critical in determining which patients will receive the most benefit from aggressive chemotherapy. The prostate-specific antigen (PSA) doubling time (PSADT) has been shown to be a surrogate for survival in earlier stages of prostate cancer, but its utility as a predictor in HRPC is unknown.
A retrospective chart review of 224 patients with HRPC treated from 1998 to 2002 was performed. Eligible patients had HRPC and evidence of metastatic disease. The PSADT at HRPC diagnosis was calculated, and the optimal PSADT stratification was obtained using the log-rank chi-square statistic. Kaplan-Meier curves were used to estimate overall survival between the groups.
During the follow-up period, 80% of patients died, 93% of prostate cancer. Overall, the median survival from diagnosis of HRPC was 15.1 months (range 0.5 to 90.5). The optimal PSADT stratification for survival was 70 days. Patients with a PSADT of 70 days or less survived 11 months compared with 19 months for those with a PSADT of more than 70 days [relative risk (RR) 1.79, P <0.0001].
PSADT serves as an independent prognostic marker for survival in patients with metastatic HRPC. Men with a PSADT of 70 days or less had a significantly shorter survival time compared with men with a PSADT of more than 70 days. Inclusion of PSADT with other clinical data could help clinicians select men at high risk of early mortality who may most benefit from aggressive treatment regimens, such as docetaxel-based regimens.
转移性激素难治性前列腺癌（HRPC）患者构成了一个异质性群体，症状范围广泛，生存期各异。患者选择对于确定哪些患者将从积极化疗中获益最大至关重要。前列腺特异性抗原（PSA）倍增时间（PSADT）已被证明是前列腺癌早期生存的替代指标，但其作为HRPC预测指标的效用尚不清楚。
对1998年至2002年接受治疗的224例HRPC患者进行回顾性病历审查。符合条件的患者患有HRPC并有转移性疾病的证据。计算HRPC诊断时的PSADT，并使用对数秩卡方统计量获得最佳PSADT分层。采用Kaplan-Meier曲线估计各组之间的总生存期。
在随访期间，80%的患者死亡，其中93%死于前列腺癌。总体而言，从HRPC诊断开始的中位生存期为15.1个月（范围为0.5至90.5个月）。生存的最佳PSADT分层为70天。PSADT为70天或更短的患者生存期为11个月，而PSADT超过70天的患者生存期为19个月[相对风险（RR）1.79，P<0.0001]。
PSADT是转移性HRPC患者生存的独立预后标志物。PSADT为70天或更短的男性与PSADT超过70天的男性相比，生存期明显更短。将PSADT与其他临床数据相结合可以帮助临床医生选择可能从积极治疗方案（如多西他赛为基础的方案）中获益最大的早期死亡高风险男性。
