King Christopher R, Freedland Stephen J, Terris Martha K, Kane Christopher J, Amling Christopher L, Aronson William J, Presti Joseph C
Division of Urologic Oncology, Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305-5847, USA.
Urology. 2007 May;69(5):921-6. doi: 10.1016/j.urology.2007.01.056.
To test the validity of preoperative prostate-specific antigen velocity (PSAV) (the rate of PSA rise before diagnosis) as a predictor for relapse after radical prostatectomy, in the context of patient obesity as measured by body mass index (BMI).
The rates of biochemical relapse were examined among 215 patients who underwent radical prostatectomy between 1992 and 2005. Kaplan-Meier relapse rates as a function of preoperative PSAV 2 ng/mL/yr or less versus greater than 2 ng/mL/yr were compared in two groups: nonobese patients (normal to overweight, BMI less than 30 kg/m2) and obese patients (mild to severely obese, BMI 30 kg/m2 or greater).
A preoperative PSAV greater than 2 ng/mL/yr was associated with higher relapse rates after radical prostatectomy compared with a PSAV of 2 ng/mL/yr or less, with 5-year relapse-free survival rates of 60% versus 70%, respectively (P = 0.03). Prostate-specific antigen velocity was independently significant on multivariate analysis, along with biopsy Gleason score, percent positive cores, and BMI. In this study 24% of patients were obese. Prostate-specific antigen velocity greater than 2 ng/mL/yr was associated with higher relapse rates in nonobese patients (P = 0.01) but not in obese patients (P = 0.9). The two BMI groups did not differ with respect to any factors. Obese patients with slowly rising PSA (PSAV 2 ng/mL/yr or less) fared just as poorly as nonobese patients with rapidly rising PSA (PSAV greater than 2 ng/mL/yr). Obesity was independently associated with higher relapse rates.
Preoperative PSAV greater than 2 ng/mL/yr was associated with a higher risk of relapse after radical prostatectomy, but its clinical usefulness might be limited to nonobese patients. Obesity conferred higher relapse rates, regardless of other prognostic factors including preoperative PSAV.
在通过体重指数（BMI）衡量患者肥胖情况的背景下，检验术前前列腺特异性抗原速度（PSAV，诊断前PSA升高速率）作为根治性前列腺切除术后复发预测指标的有效性。
对1992年至2005年间接受根治性前列腺切除术的215例患者的生化复发率进行了检查。比较了两组患者的Kaplan-Meier复发率，这两组分别为：术前PSAV为2 ng/mL/年或更低与高于2 ng/mL/年的患者，其中又分为非肥胖患者（正常至超重，BMI小于30 kg/m²）和肥胖患者（轻度至重度肥胖，BMI为30 kg/m²或更高）。
与PSAV为2 ng/mL/年或更低相比，术前PSAV高于2 ng/mL/年与根治性前列腺切除术后更高的复发率相关，5年无复发生存率分别为60%和70%（P = 0.03）。在多变量分析中，前列腺特异性抗原速度与活检Gleason评分、阳性核心百分比和BMI一样，具有独立的显著性。在本研究中，24%的患者为肥胖患者。PSAV高于2 ng/mL/年与非肥胖患者更高的复发率相关（P = 0.01），但与肥胖患者无关（P = 0.9）。两个BMI组在任何因素方面均无差异。PSA缓慢升高（PSAV为2 ng/mL/年或更低）的肥胖患者与PSA快速升高（PSAV高于2 ng/mL/年）的非肥胖患者预后同样差。肥胖与更高的复发率独立相关。
术前PSAV高于2 ng/mL/年与根治性前列腺切除术后更高的复发风险相关，但其临床实用性可能仅限于非肥胖患者。无论包括术前PSAV在内的其他预后因素如何，肥胖都会导致更高的复发率。
