Swanson Gregory P, Hussey Michael A, Tangen Catherine M, Chin Joseph, Messing Edward, Canby-Hagino Edith, Forman Jeffrey D, Thompson Ian M, Crawford E David
Department of Radiation Oncology and Urology, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA.
J Clin Oncol. 2007 Jun 1;25(16):2225-9. doi: 10.1200/JCO.2006.09.6495.
Southwest Oncology Group (SWOG) trial 8794 demonstrated that adjuvant radiation reduces the risk of biochemical (prostate-specific antigen [PSA]) treatment failure by 50% over radical prostatectomy alone. In this analysis, we stratified patients as to their preradiation PSA levels and correlated it with outcomes such as PSA treatment failure, local recurrence, and distant failure, to serve as guidelines for future research.
Four hundred thirty-one subjects with pathologically advanced prostate cancer (extraprostatic extension, positive surgical margins, or seminal vesicle invasion) were randomly assigned to adjuvant radiotherapy or observation.
Three hundred seventy-four eligible patients had immediate postprostatectomy and follow-up PSA data. Median follow-up was 10.2 years. For patients with a postsurgical PSA of 0.2 ng/mL, radiation was associated with reductions in the 10-year risk of biochemical treatment failure (72% to 42%), local failures (20% to 7%), and distant failures (12% to 4%). For patients with a postsurgical PSA between higher than 0.2 and <or = 1.0 ng/mL, reductions in the 10-year risk of biochemical failure (80% to 73%), local failures (25% to 9%), and distant failures (16% to 12%) were realized. In patients with postsurgical PSA higher than 1.0, the respective findings were 94% versus 100%, 28% versus 9%, and 44% versus 18%.
The pattern of treatment failure in high-risk patients is predominantly local with a surprisingly low incidence of metastatic failure. Adjuvant radiation to the prostate bed reduces the risk of metastatic disease and biochemical failure at all postsurgical PSA levels. Further improvement in reducing local treatment failure is likely to have the greatest impact on outcome in high-risk patients after prostatectomy.
西南肿瘤协作组（SWOG）8794试验表明，辅助放疗相较于单纯根治性前列腺切除术，可将生化（前列腺特异性抗原[PSA]）治疗失败风险降低50%。在本分析中，我们根据患者放疗前的PSA水平进行分层，并将其与PSA治疗失败、局部复发和远处转移失败等结果相关联，以作为未来研究的指导。
431例病理分期为晚期前列腺癌（前列腺外侵犯、手术切缘阳性或精囊侵犯）的受试者被随机分配至辅助放疗组或观察组。
374例符合条件的患者有前列腺切除术后即刻及随访的PSA数据。中位随访时间为10.2年。对于术后PSA为0.2 ng/mL的患者，放疗可使10年生化治疗失败风险（从72%降至4 — ）、局部复发风险（从20%降至7%）和远处转移失败风险（从12%降至4%）降低。对于术后PSA高于0.2且≤1.0 ng/mL的患者，10年生化失败风险（从80%降至73%）、局部复发风险（从25%降至9%）和远处转移失败风险（从16%降至12%）均有所降低。对于术后PSA高于1.0的患者，相应结果分别为94%对100%、28%对9%、44%对18%。
高危患者的治疗失败模式主要为局部复发，远处转移失败发生率出奇地低。对前列腺床进行辅助放疗可降低所有术后PSA水平患者的转移疾病风险和生化失败风险。进一步降低局部治疗失败率可能对前列腺切除术后高危患者的预后产生最大影响。
