Stephenson Andrew J, Scardino Peter T, Kattan Michael W, Pisansky Thomas M, Slawin Kevin M, Klein Eric A, Anscher Mitchell S, Michalski Jeff M, Sandler Howard M, Lin Daniel W, Forman Jeffrey D, Zelefsky Michael J, Kestin Larry L, Roehrborn Claus G, Catton Charles N, DeWeese Theodore L, Liauw Stanley L, Valicenti Richard K, Kuban Deborah A, Pollack Alan
Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195-0001, USA.
J Clin Oncol. 2007 May 20;25(15):2035-41. doi: 10.1200/JCO.2006.08.9607.
An increasing serum prostate-specific antigen (PSA) level is the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy. Salvage radiation therapy (SRT) may eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lack adequate sensitivity and specificity. We developed a nomogram to predict the probability of cancer control at 6 years after SRT for PSA-defined recurrence.
Using multivariable Cox regression analysis, we constructed a model to predict the probability of disease progression after SRT in a multi-institutional cohort of 1,540 patients.
The 6-year progression-free probability was 32% (95% CI, 28% to 35%) overall. Forty-eight percent (95% CI, 40% to 56%) of patients treated with SRT alone at PSA levels of 0.50 ng/mL or lower were disease free at 6 years, including 41% (95% CI, 31% to 51%) who also had a PSA doubling time of 10 months or less or poorly differentiated (Gleason grade 8 to 10) cancer. Significant variables in the model were PSA level before SRT (P < .001), prostatectomy Gleason grade (P < .001), PSA doubling time (P < .001), surgical margins (P < .001), androgen-deprivation therapy before or during SRT (P < .001), and lymph node metastasis (P = .019). The resultant nomogram was internally validated and had a concordance index of 0.69.
Nearly half of patients with recurrent prostate cancer after radical prostatectomy have a long-term PSA response to SRT when treatment is administered at the earliest sign of recurrence. The nomogram we developed predicts the outcome of SRT and should prove valuable for medical decision making for patients with a rising PSA level.
血清前列腺特异性抗原（PSA）水平升高是接受根治性前列腺切除术患者复发性前列腺癌的初始迹象。挽救性放射治疗（SRT）可能根除局部复发性癌症，但区分局部复发与全身复发的研究缺乏足够的敏感性和特异性。我们开发了一种列线图，以预测PSA定义的复发患者接受SRT后6年癌症控制的概率。
使用多变量Cox回归分析，我们构建了一个模型，以预测1540例多机构队列患者接受SRT后疾病进展的概率。
总体而言，6年无进展概率为32%（95%CI，28%至35%）。PSA水平为0.50 ng/mL或更低时单独接受SRT治疗的患者中，48%（95%CI，40%至56%）在6年时无疾病，其中包括41%（95%CI，31%至51%）PSA加倍时间为10个月或更短或为低分化（Gleason分级8至10）癌症的患者。模型中的显著变量为SRT前的PSA水平（P <.001）、前列腺切除术后Gleason分级（P <.001）、PSA加倍时间（P <.001）、手术切缘（P <.001）、SRT前或期间的雄激素剥夺治疗（P <.001）以及淋巴结转移（P =.019）。所得列线图经内部验证，一致性指数为0.69。
根治性前列腺切除术后复发性前列腺癌患者中，近一半在复发最早迹象时接受治疗对SRT有长期PSA反应。我们开发的列线图可预测SRT的结果，对PSA水平升高的患者进行医疗决策应具有重要价值。
