单独近距离放射治疗以及联合激素治疗和/或外照射放疗后，5年前列腺特异性抗原（PSA）值对预测前列腺癌复发的预后意义。

Prognostic significance of 5-year PSA value for predicting prostate cancer recurrence after brachytherapy alone and combined with hormonal therapy and/or external beam radiotherapy.

作者信息

Stock Richard G, Klein Thomas J, Cesaretti Jamie A, Stone Nelson N

机构信息

Department of Radiation Oncology, Mount Sinai Hospital, New York, NY 10029, USA.

出版信息

Int J Radiat Oncol Biol Phys. 2009 Jul 1;74(3):753-8. doi: 10.1016/j.ijrobp.2008.08.049. Epub 2008 Dec 10.

DOI:10.1016/j.ijrobp.2008.08.049

PMID:19084351

Abstract

PURPOSE

To analyze the prognosis and outcomes of patients who remain free of biochemical failure during the first 5 years after treatment.

METHODS AND MATERIALS

Between 1991 and 2002, 742 patients with prostate cancer were treated with brachytherapy alone (n = 306), brachytherapy and hormonal therapy (n = 212), or combined implantation and external beam radiotherapy (with or without hormonal therapy; n = 224). These patients were free of biochemical failure (American Society for Therapeutic Radiology and Oncology [ASTRO] definition) during the first 5 post-treatment years and had a documented 5-year prostate-specific antigen (PSA) value. The median follow-up was 6.93 years.

RESULTS

The actuarial 10-year freedom from PSA failure rate was 97% using the ASTRO definition and 95% using the Phoenix definition. The median 5-year PSA level was 0.03 ng/mL (range, 0-3.6). The 5-year PSA value was <or=0.01 in 47.7%, >0.01-0.10 in 31.1%, >0.10-0.2 in 10.2%, >0.2-0.5 in 7.82%, and >0.5 in 3.10%. The 5-year PSA value had prognostic significance, with a PSA value of <or=0.2 ng/mL (n = 661) corresponding to a 10-year freedom from PSA failure rate of 99% with the ASTRO definition and 98% with the Phoenix definition vs. 86% (ASTRO definition) and 81% (Phoenix definition) for a PSA value >or=0.2 ng/mL (n = 81; p < .0001). The treatment regimen had no effect on biochemical failure. None of the 742 patients in this study developed metastatic disease or died of prostate cancer.

CONCLUSION

The results of this study have shown that the prognosis for patients treated with brachytherapy and who remain biochemically free of disease for >or=5 years is excellent and none developed metastatic disease during the first 10 years after treatment. The 5-year PSA value is prognostic, and patients with a PSA value <0.2 ng/mL are unlikely to develop subsequent biochemical relapse.

摘要

目的

分析治疗后前5年无生化失败患者的预后及结局。

方法和材料

1991年至2002年期间，742例前列腺癌患者接受了单纯近距离放射治疗（n = 306）、近距离放射治疗与激素治疗（n = 212）或联合植入及外照射放疗（有或无激素治疗；n = 224）。这些患者在治疗后的前5年无生化失败（根据美国放射肿瘤学会[ASTRO]定义），且有记录的5年前列腺特异性抗原（PSA）值。中位随访时间为6.93年。

结果

根据ASTRO定义，精算10年无PSA失败率为97%，根据Phoenix定义为95%。中位5年PSA水平为0.03 ng/mL（范围，0 - 3.6）。5年PSA值≤0.01者占47.7%，>0.01 - 0.10者占31.1%，>0.10 - 0.2者占10.2%，>0.2 - 0.5者占7.82%，>0.5者占3.10%。5年PSA值具有预后意义，PSA值≤0.2 ng/mL（n = 661）的患者，根据ASTRO定义10年无PSA失败率为99%，根据Phoenix定义为98%；而PSA值≥0.2 ng/mL（n = 81）的患者，相应比率分别为86%（ASTRO定义）和81%（Phoenix定义）（p <.0001）。治疗方案对生化失败无影响。本研究中的742例患者均未发生转移性疾病或死于前列腺癌。