Nurani Rizwan, Wallner Kent, Merrick Gregory, Virgin Jeffrey, Orio Peter, True Lawrence D
Department of Radiation Oncology, Puget Sound Health Care System, Seattle, Washington 98108-1597, USA.
J Urol. 2007 Nov;178(5):1968-73; discussion 1973. doi: 10.1016/j.juro.2007.07.033. Epub 2007 Sep 17.
A higher percent of positive biopsy cores predicts poor biochemical failure-free survival. The highest dose covering at least 90% of the prostate is a standard method of measuring implant quality. We tested the hypothesis that the percentage of positive biopsy cores loses its adverse prognostic impact in patients who receive implants with a highest dose covering at least 90% of the prostate of 100% or greater of the prescription dose.
A total of 568 patients with intermediate to high risk adenocarcinoma of the prostate who were previously treated with brachytherapy in a prospective, randomized study were evaluated. The relationship between the percentage of positive biopsy cores, the highest dose covering at least 90% of the prostate and biochemical failure was examined.
At a median followup of 50 months the rate of 5-year biochemical failure-free survival was 87% for the entire group and 92% vs 81% for patients with less than 50% vs 50% or greater positive biopsy cores (log rank p = 0.009). The mean highest dose covering at least 90% of the prostate was statistically lower in failing vs nonfailing cases (p = 0.03). Gleason score, prostate specific antigen, 50% or greater positive biopsy cores and the highest dose covering at least 90% of the prostate were the only statistically significant predictive factors for biochemical failure-free survival on multivariate Cox regression analysis. When regression analysis was restricted to the 237 patients who received implants with a highest dose covering at least 90% of the prostate of 100% or greater, 50% or greater positive biopsy cores lost predictive value but prostate specific antigen and Gleason score remained independent prognostic factors.
A total of 50% or greater positive biopsy cores is an independent predictor of poor biochemical failure-free survival in patients treated with brachytherapy. High quality prostate brachytherapy, defined by a highest dose covering at least 90% of the prostate of 100% or greater, minimize the adverse effect of 50% or greater positive biopsy cores on time to biochemical failure.
活检阳性核心比例越高，预示无生化失败生存期越差。覆盖至少90%前列腺的最高剂量是衡量植入质量的标准方法。我们检验了这样一个假设：在接受植入治疗且覆盖至少90%前列腺的最高剂量达到或超过处方剂量100%的患者中，活检阳性核心比例失去其不良预后影响。
对568例曾在前瞻性随机研究中接受近距离放射治疗的中高危前列腺腺癌患者进行评估。研究了活检阳性核心比例、覆盖至少90%前列腺的最高剂量与生化失败之间的关系。
中位随访50个月时，全组5年无生化失败生存率为87%，活检阳性核心比例小于50%的患者为92%，而活检阳性核心比例为50%或更高的患者为81%（对数秩检验p = 0.009）。失败组与未失败组相比，覆盖至少90%前列腺的平均最高剂量在统计学上较低（p = 0.03）。在多因素Cox回归分析中， Gleason评分、前列腺特异性抗原、活检阳性核心比例为50%或更高以及覆盖至少90%前列腺的最高剂量是无生化失败生存期的唯一具有统计学意义的预测因素。当回归分析仅限于237例接受植入治疗且覆盖至少90%前列腺的最高剂量达到或超过处方剂量100%的患者时，活检阳性核心比例为50%或更高失去了预测价值，但前列腺特异性抗原和Gleason评分仍然是独立的预后因素。
活检阳性核心比例为50%或更高是接受近距离放射治疗患者无生化失败生存期差的独立预测因素。高质量的前列腺近距离放射治疗，定义为覆盖至少90%前列腺的最高剂量达到或超过处方剂量100%，可将活检阳性核心比例为50%或更高对生化失败时间的不良影响降至最低。
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