Everly Lydia, Merrick Gregory S, Allen Zachariah A, Butler Wayne M, Wallner Kent, Lief Jonathan H, Galbreath Robert W, Adamovich Edward
Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV, USA.
Brachytherapy. 2009 Jan-Mar;8(1):57-62. doi: 10.1016/j.brachy.2008.08.001. Epub 2008 Oct 26.
In this study, we evaluated the impact of Agent Orange exposure on survival in Vietnam Veterans undergoing prostate brachytherapy.
From May 1995 to January 2005, 81 Vietnam veterans (29 with Agent Orange exposure and 52 without) and 433 nonveterans of comparable age (mean age, 58 years) underwent prostate brachytherapy. The mean follow-up was 5.0 years. Biochemical progression-free survival (bPFS) was defined as a prostate-specific antigen (PSA)< or =0.40ng/mL after nadir. Patients with metastatic prostate cancer or hormone refractory disease without obvious metastases who died of any cause were classified as died of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple parameters were evaluated for impact on survival.
At 9 years, Agent Orange-exposed men were least likely to remain biochemically controlled (89.5%, 100%, and 97.2% in Agent Orange-exposed, nonexposed veterans, and nonveterans, respectively, p=0.012). No significant differences in cause-specific (CSS) (p=0.832) or overall survival (OS) (p=0.363) were discerned. In multivariate analysis, CSS was best predicted by Gleason Score and day 0 D(90), whereas Gleason Score, % positive biopsies, and D(90) predicted for bPFS. None of the evaluated parameters predicted for OS, however, a trend was identified for better OS in younger patients and those with a higher D(90). In addition, Agent Orange exposure did not predict for any of the survival parameters. To date, 22 patients have died (metastatic prostate cancer two, second malignancies nine, cardiovascular disease eight, trauma two, and pulmonary one).
In this cohort of prostate brachytherapy patients, Agent Orange exposure did not statistically impact survival in multivariate analysis.
在本研究中，我们评估了接触橙剂对接受前列腺近距离放射治疗的越南退伍军人存活率的影响。
1995年5月至2005年1月，81名越南退伍军人（29名接触橙剂者和52名未接触者）以及433名年龄相仿（平均年龄58岁）的非退伍军人接受了前列腺近距离放射治疗。平均随访时间为5.0年。生化无进展生存期（bPFS）定义为最低点后前列腺特异性抗原（PSA）≤0.40ng/mL。患有转移性前列腺癌或无明显转移的激素难治性疾病且因任何原因死亡的患者被归类为死于前列腺癌。所有其他死亡归因于直接死因。评估了多个参数对存活率的影响。
9年后，接触橙剂的男性生化控制的可能性最小（接触橙剂者、未接触的退伍军人和非退伍军人分别为89.5%、100%和97.2%，p = 0.012）。在特定病因生存率（CSS）（p = 0.832）或总生存率（OS）（p = 0.363）方面未发现显著差异。在多变量分析中，CSS最好由 Gleason评分和第0天的D(90)预测，而Gleason评分、阳性活检百分比和D(90)可预测bPFS。然而，所评估的参数均不能预测OS，不过在年轻患者和D(90)较高的患者中发现了OS较好的趋势。此外，接触橙剂不能预测任何生存参数。迄今为止，已有22名患者死亡（转移性前列腺癌2例，第二原发性恶性肿瘤9例，心血管疾病8例，创伤2例，肺部疾病1例）。
在这个前列腺近距离放射治疗患者队列中，多变量分析显示接触橙剂对生存率没有统计学上的影响。
