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生化复发前列腺癌早期激素消融的生存获益

Survival benefit for early hormone ablation in biochemically recurrent prostate cancer.

作者信息

Tenenholz Todd C, Shields Christian, Ramesh V Ramakrishnan, Tercilla Oscar, Hagan Michael P

机构信息

Department of Radiation Oncology, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, VA 23298-0058, USA.

出版信息

Urol Oncol. 2007 Mar-Apr;25(2):101-9. doi: 10.1016/j.urolonc.2006.03.002.

Abstract

PURPOSE

To determine whether early initiation of androgen ablation in patients with biochemically recurrent prostate cancer, but without clinically evident metastases, is associated with improved overall or disease-specific survival. To describe subgroups, based on PSA kinetics, which are most likely to benefit from early androgen ablation.

MATERIALS AND METHODS

A retrospective cohort of 124 patients, who were definitively treated by external beam radiotherapy between 1988 and 1999, and subsequently received androgen ablation for biochemical (92 patients) or clinically metastatic (32 patients) failure, was reviewed. Median follow-up time was 6.2 years. Overall survival, disease-specific survival, and hormonal control were examined and compared for patients whose hormone ablation was started early (prostate-specific antigen [PSA] <or=15 ng/ml or PSA doubling time >7 months) or late in the course of their biochemical failure.

RESULTS

All patients had biochemical response to hormone initiation, with a median PSA nadir of 0.05 ng/ml. Early initiation of hormone ablation resulted in statistically significant improvement in all outcome measures. Multivariate analysis indicated that PSA doubling time at hormone initiation was the most consistent predictor of outcome. The 5-year overall survival was 78% for patients whose androgen ablation was initiated at doubling time <or=7 months and 93% for patients when initiated at doubling time >7 months. Mean survival improved from 84.9 +/- 4.6 (doubling time <or=7) to 115.3 +/- 8.4 months (doubling time >7). Survival for patients started on hormones with doubling time <5 months was similar to that of patients with clinical metastases.

CONCLUSIONS

This survival benefit justifies the use of androgen ablation in patients whose doubling time approaches 7 months. A randomized trial is needed to confirm these findings, investigate potential benefit for patients with longer doubling times, and gather data on the morbidity of early hormone ablation, including quality of life issues.

摘要

目的

确定对于生化复发但无临床明显转移的前列腺癌患者,早期开始雄激素剥夺治疗是否与总体生存率或疾病特异性生存率的提高相关。描述基于前列腺特异性抗原(PSA)动力学的亚组,这些亚组最有可能从早期雄激素剥夺治疗中获益。

材料与方法

回顾性分析了124例患者的队列,这些患者在1988年至1999年间接受了外照射放疗,并随后因生化(92例患者)或临床转移(32例患者)失败而接受雄激素剥夺治疗。中位随访时间为6.2年。对激素剥夺治疗开始早(前列腺特异性抗原[PSA]≤15 ng/ml或PSA倍增时间>7个月)或在生化失败过程中晚期开始治疗的患者,检查并比较其总体生存率、疾病特异性生存率和激素控制情况。

结果

所有患者对激素治疗均有生化反应,PSA最低点中位数为0.05 ng/ml。早期开始激素剥夺治疗在所有结局指标上均有统计学显著改善。多变量分析表明,激素治疗开始时的PSA倍增时间是最一致的结局预测指标。当PSA倍增时间≤7个月时开始雄激素剥夺治疗的患者,其5年总体生存率为78%;当倍增时间>7个月时开始治疗的患者,5年总体生存率为93%。平均生存期从84.9±4.6个月(倍增时间≤7)提高到115.3±8.4个月(倍增时间>7)。PSA倍增时间<5个月开始接受激素治疗的患者生存率与临床转移患者相似。

结论

这种生存获益证明了对于倍增时间接近7个月的患者使用雄激素剥夺治疗是合理的。需要进行一项随机试验来证实这些发现,研究更长倍增时间患者的潜在获益,并收集早期激素剥夺治疗的发病率数据,包括生活质量问题。

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