Spalding Aaron C, Daignault Stephanie, Sandler Howard M, Shah Rajal B, Pan Charlie C, Ray Michael E
Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.
Urology. 2007 May;69(5):936-40. doi: 10.1016/j.urology.2007.01.066.
To examine the prognostic value of percent positive cores (PPC) in prostate cancer patients treated with external beam radiotherapy (RT).
An institutional review board-approved, retrospective analysis was conducted on 814 patients treated with RT with or without hormonal therapy between 1984 and 2002. Percent positive cores (number of positive cores divided by total number of cores) was calculable for 591 patients with a median follow-up of 65 months. Univariate and multivariable analyses were performed using Kaplan-Meier and Cox proportional hazard methods relating PPC to other risk factors, biochemical/clinical disease-free survival (PSA-DFS), prostate cancer-specific survival (DSS), and overall survival (OS).
Percent positive cores was associated with stage, Gleason score (GS), pretreatment serum prostate-specific antigen (PSA) level, and use of adjunctive androgen suppression therapy. The 5-year PSA-DFS, DSS, and OS rates were 80%, 99%, and 91%, respectively, for patients with PPC less than 50%, compared with 56%, 94%, and 87% for patients with PPC 50% or greater (P <0.0001, <0.004, and <0.04, respectively). Multivariable analysis revealed that PPC, stage, GS, PSA, and androgen suppression therapy were all significantly associated with PSA-DFS, whereas only GS was associated with DSS and OS. For high, intermediate, and low-risk patients, 5-year PSA-DFS was 62% versus 39%, 80% versus 59%, and 90% versus 82% for PPC less than 50% versus PPC 50% or greater, respectively.
Percent positive cores predicts outcome of prostate cancer patients treated with RT, independently of other known prognostic factors. Percent positive cores may have particular use for further risk stratification within established clinical risk categories.
探讨接受外照射放疗（RT）的前列腺癌患者中阳性核心百分比（PPC）的预后价值。
对1984年至2002年间接受RT治疗（无论是否接受激素治疗）的814例患者进行了一项经机构审查委员会批准的回顾性分析。591例患者可计算出阳性核心百分比（阳性核心数量除以核心总数），中位随访时间为65个月。使用Kaplan-Meier法和Cox比例风险法进行单变量和多变量分析，将PPC与其他风险因素、生化/临床无病生存（PSA-DFS）、前列腺癌特异性生存（DSS）和总生存（OS）相关联。
阳性核心百分比与分期、Gleason评分（GS）、治疗前血清前列腺特异性抗原（PSA）水平以及辅助雄激素抑制治疗的使用有关。PPC小于50%的患者5年PSA-DFS、DSS和OS率分别为80%、99%和91%，而PPC为50%或更高的患者分别为56%、94%和87%（P分别<0.0001、<0.004和<0.04）。多变量分析显示，PPC、分期、GS、PSA和雄激素抑制治疗均与PSA-DFS显著相关，而只有GS与DSS和OS相关。对于高、中、低风险患者，PPC小于50%与PPC为50%或更高相比，5年PSA-DFS分别为62%对39%、80%对59%和90%对82%。
阳性核心百分比可预测接受RT治疗的前列腺癌患者的预后，独立于其他已知的预后因素。阳性核心百分比可能对既定临床风险类别内的进一步风险分层具有特殊用途。
