Swanson Gregory P, Goldman Bryan, Tangen Catherine M, Chin Joseph, Messing Edward, Canby-Hagino Edith, Forman Jeffrey D, Thompson Ian M, Crawford E David
University of Texas Health Science Center, San Antonio, Texas 78229-3900, USA.
J Urol. 2008 Dec;180(6):2453-7; discussion 2458. doi: 10.1016/j.juro.2008.08.037. Epub 2008 Oct 19.
From the randomized study Southwest Oncology Group 8794 we evaluated the effect of seminal vesicle involvement on outcomes and whether those patients benefited from post-prostatectomy adjuvant radiation therapy.
Southwest Oncology Group study 8794 randomized high risk patients (with seminal vesicle positive disease and/or capsular penetration and/or positive margins) to radiation vs observation after prostatectomy. A total of 431 subjects with pathologically advanced prostate cancer were randomized.
Median followup was 12.2 years. Of the patients 139 had seminal vesicle involvement with or without capsular penetration and/or positive margins. Compared to the 286 patients with seminal vesicle negative disease there was poorer 10-year biochemical failure-free survival (33% for seminal vesicle negative and 22% for seminal vesicle positive, p = 0.04), metastasis-free survival (70% and 56%, respectively, p = 0.005) and overall survival (10-year overall survival 74% and 61%, respectively, p = 0.02) for those with seminal vesicle positive disease. Patients with seminal vesicle positive disease who received adjuvant radiation compared to observation realized an improvement in 10-year biochemical failure-free survival from 12% to 36% (p = 0.001), in 10-year overall survival from 51% to 71% (p = 0.08) and in metastasis-free survival from 47% to 66% (p = 0.09), respectively.
Although seminal vesicle involvement is a negative prognostic factor, long-term control is possible especially if patients are given adjuvant radiation therapy. This therapy appears to be effective in patients with seminal vesicle involvement.
通过西南肿瘤协作组8794号随机研究，我们评估了精囊受累对预后的影响，以及这些患者是否能从前列腺切除术后辅助放疗中获益。
西南肿瘤协作组8794号研究将高危患者（精囊阳性疾病和/或包膜侵犯和/或切缘阳性）随机分为前列腺切除术后放疗组和观察组。共有431例病理分期为晚期前列腺癌的患者被随机分组。
中位随访时间为12.2年。139例患者存在精囊受累，伴或不伴有包膜侵犯和/或切缘阳性。与286例精囊阴性疾病患者相比，精囊阳性疾病患者的10年无生化复发生存率较低（精囊阴性为33%，精囊阳性为22%，p = 0.04），无转移生存率较低（分别为70%和56%，p = 0.005），总生存率较低（10年总生存率分别为74%和61%，p = 0.02）。与观察组相比，接受辅助放疗的精囊阳性疾病患者的10年无生化复发生存率从12%提高到36%（p = 0.001），10年总生存率从51%提高到71%（p = 0.08），无转移生存率从47%提高到66%（p = 0.09）。
虽然精囊受累是一个不良预后因素，但长期控制是可能的，特别是如果患者接受辅助放疗。这种治疗方法似乎对精囊受累的患者有效。
