Liauw Stanley L, Fricano Janine, Correa David, Weichselbaum Ralph R, Jani Ashesh B
Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA.
Cancer. 2009 Apr 15;115(8):1784-90. doi: 10.1002/cncr.24176.
Randomized trials supported the use of androgen deprivation therapy (ADT) with radiation therapy (RT) for intermediate-risk prostate cancer. However, the value of concurrent ADT was less certain with dose-escalated RT. Better methods of stratifying patients in this risk group may help select patients who are most likely to benefit.
A total of 238 men with intermediate-risk (prostate specific antigen [PSA] 10-20, Gleason 7, or stage T2b-c) adenocarcinoma of the prostate were treated with external beam RT between 1989 and 2006. Patients had Gleason< or =6 (39%) or 7 (61%) tumors; median PSA was 10.5 ng/mL. A median of 37.5% of biopsy cores were positive from a median of 9 biopsy cores sampled. The median RT dose was 74 Gy to the prostate. A total of 112 patients (47%) received neoadjuvant and concurrent ADT (median, 4 months). Median follow-up period was 49 months.
The freedom from biochemical failure (FFBF, nadir + 2 definition) was 93% at 3 years, 86% at 4 years, and 80% at 5 years. On univariate analysis, the only factor associated with FFBF was percentage of positive cores (PPC, P = .0340). The prognostic value of PPC> or =50 was not evident in patients receiving ADT (FFBF at 4 years 90% vs 91%, P = .3015). For patients not receiving ADT, the impact of PPC> or =50 (FFBF at 4 years 76% vs 93%, P = .0844) was more pronounced. On multivariate analysis, PPC (P = .0388) was significantly associated with FFBF, whereas Gleason sum, ADT, RT dose, PSA, and T-stage were not.
After dose-escalated external beam RT, intermediate-risk prostate cancer patients with PPC> or =50 had the highest risk for biochemical failure and may be most likely to derive a benefit from ADT.
随机试验支持对中危前列腺癌采用雄激素剥夺疗法（ADT）联合放射治疗（RT）。然而，对于剂量递增的RT，同期ADT的价值尚不确定。在这个风险组中更好地对患者进行分层的方法可能有助于选择最有可能获益的患者。
1989年至2006年间，共有238例患有中危（前列腺特异性抗原[PSA]为10 - 20、Gleason评分为7或T2b - c期）前列腺腺癌的男性接受了外照射RT。患者的肿瘤Gleason评分≤6（39%）或为7（61%）；PSA中位数为10.5 ng/mL。从平均9个活检样本核心中，平均37.5%的活检核心呈阳性。前列腺的中位RT剂量为74 Gy。共有112例患者（47%）接受了新辅助和同期ADT（中位时间为4个月）。中位随访期为49个月。
3年时无生化失败（FFBF，最低点+2定义）率为93%，4年时为86%，5年时为80%。单因素分析显示，与FFBF相关的唯一因素是阳性核心百分比（PPC，P = 0.0340）。在接受ADT的患者中，PPC≥50的预后价值不明显（4年时FFBF为90%对91%，P = 0.3015）。对于未接受ADT的患者，PPC≥50的影响（4年时FFBF为76%对93%，P = 0.0844）更为显著。多因素分析显示，PPC（P = 0.0388）与FFBF显著相关，而Gleason总分、ADT、RT剂量、PSA和T分期则不然。
在剂量递增的外照射RT后，PPC≥50的中危前列腺癌患者生化失败风险最高，可能最有可能从ADT中获益。
