Phillips Joseph J, Hall M Craig, Lee W Robert, Clark Peter E
Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Urol Oncol. 2007 May-Jun;25(3):196-200. doi: 10.1016/j.urolonc.2006.06.004.
To assess whether a delay in initiating definitive therapy for clinically localized prostate cancer affects outcome.
We retrospectively reviewed 393 men with localized prostate cancer treated with radiation therapy or surgery without systemic therapy between 1991 and 2004. Data included: time from diagnosis to treatment initiation (more or less than 3 months); biopsy Gleason score grouped by low (2-6), intermediate (7), or high risk (8-10); clinical stage grouped by low (T1/T2a) or high risk (T2b or higher); pretreatment prostate-specific antigen (PSA) grouped by low (<10 ng/ml), intermediate (10-20), or high risk (>20); and biochemical recurrence-free survival.
Median patient age was 63.1 years (range 39.7-79.5). Median pretreatment PSA was 6.5 ng/ml (range 0.4-411). Median time from diagnosis to treatment was 57 days (range 8-2927). A total of 310 patients (79%) were treated within 3 months. Median follow-up was 2.3 years (range 0.1-14.0). On univariate analysis using Kaplan-Meier survival curves and the log-rank test, only pretreatment PSA was associated with worse biochemical recurrence-free survival (P = 0.008). Biochemical recurrence-free survival was not associated with time from diagnosis to treatment (P = 0.28), clinical stage (P = 0.50), or biopsy Gleason score (P = 0.19). The results were the same when analyzed in a multivariable analysis using the Cox proportional hazards model.
A delay in treatment of > or =3 months does not appear to affect adversely biochemical recurrence-free survival in patients who undergo definitive therapy for clinically localized prostate cancer in those with low risk features.
评估临床局限性前列腺癌确诊后延迟开始确定性治疗是否会影响治疗结果。
我们回顾性分析了1991年至2004年间393例接受放射治疗或手术且未接受全身治疗的局限性前列腺癌男性患者。数据包括：从诊断到开始治疗的时间（大于或小于3个月）；活检Gleason评分，分为低风险（2 - 6）、中风险（7）或高风险（8 - 10）；临床分期，分为低风险（T1/T2a）或高风险（T2b及以上）；治疗前前列腺特异性抗原（PSA），分为低水平（<10 ng/ml）、中等水平（10 - 20）或高风险（>20）；以及无生化复发生存期。
患者中位年龄为63.1岁（范围39.7 - 79.5岁）。治疗前PSA中位值为6.5 ng/ml（范围0.4 - 411）。从诊断到治疗的中位时间为57天（范围8 - 2927天）。共有310例患者（79%）在3个月内接受了治疗。中位随访时间为2.3年（范围0.1 - 14.0年）。使用Kaplan - Meier生存曲线和对数秩检验进行单因素分析时，仅治疗前PSA与较差的无生化复发生存期相关（P = 0.008）。无生化复发生存期与从诊断到治疗的时间（P = 0.28）、临床分期（P = 0.50）或活检Gleason评分（P = 0.19）无关。使用Cox比例风险模型进行多因素分析时结果相同。
对于具有低风险特征的临床局限性前列腺癌患者，治疗延迟≥3个月似乎不会对其无生化复发生存期产生不利影响。
