Pe Mark L, Trabulsi Edouard J, Kedika Ramalinga, Pequignot Edward, Dicker Adam P, Gomella Leonard G, Valicenti Richard K
Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Urology. 2009 Jun;73(6):1328-34. doi: 10.1016/j.urology.2008.09.078. Epub 2009 Apr 18.
To investigate the significance of the percentage of positive biopsy cores (PPBCs) in predicting the biochemical outcome in patients with low-risk prostate cancer undergoing brachytherapy or three-dimensional conformal external beam radiotherapy (3D-CRT).
We retrospectively reviewed 360 patients with low-risk prostate cancer who had undergone low dose-rate brachytherapy ((125)I) or 3D-CRT from 1993 to 2006. Of the 360 patients, 189 had undergone 3D-CRT and 171 had undergone brachytherapy. The patients were stratified according to treatment modality and PPBCs (<34%, 34%-50%, >50%). Biochemical failure was defined by the 2006 Radiation Therapy Oncology Group-American Society for Therapeutic Radiology and Oncology, Phoenix Consensus Conference definition.
The median follow-up in the 3D-CRT and brachytherapy groups was 51 and 37 months, respectively. The number of patients who had a PPBCs of <34%, 34%-50%, and >50% in the 3D-CRT and brachytherapy cohorts was 154, 26, and 9 and 133, 25, and 15, respectively. The 5-year freedom from biochemical failure rate for 3D-CRT and brachytherapy was 95% and 96%, respectively; the corresponding median prostate-specific antigen nadirs were 0.7 and 0.3 ng/mL (P < .001). No significant differences were found in age, stage, Gleason score, or PPBCs between the 2 cohorts. Cox regression analysis showed that the pretreatment prostate-specific antigen level, stage, PPBCs, and treatment modality did not predict for the time to biochemical failure. When stratified by PPBCs, no significant difference in FFBF for either modality was seen.
In patients with low-risk prostate cancer, brachytherapy and 3D-CRT remain excellent treatment choices, regardless of the tumor volume as estimated by the PPBCs. Longer follow-up and the recruitment of men with a greater volume of disease (>50% PPBCs) are needed to confirm these preliminary findings.
探讨穿刺活检阳性核心比例（PPBCs）在预测接受近距离放疗或三维适形外照射放疗（3D-CRT）的低危前列腺癌患者生化结局中的意义。
我们回顾性分析了1993年至2006年间接受低剂量率近距离放疗（碘-125）或3D-CRT的360例低危前列腺癌患者。在这360例患者中，189例接受了3D-CRT，171例接受了近距离放疗。患者根据治疗方式和PPBCs（<34%、34%-50%、>50%）进行分层。生化失败按照2006年放射肿瘤学组-美国放射治疗及肿瘤学会菲尼克斯共识会议的定义来界定。
3D-CRT组和近距离放疗组的中位随访时间分别为51个月和37个月。3D-CRT队列和近距离放疗队列中PPBCs<34%、34%-50%、>50%的患者数量分别为154例、26例、9例和133例、25例、15例。3D-CRT和近距离放疗的5年无生化失败生存率分别为95%和96%；相应的前列腺特异性抗原最低值中位数分别为0.7和0.3 ng/mL（P<.001）。两组在年龄、分期、Gleason评分或PPBCs方面均未发现显著差异。Cox回归分析显示，治疗前前列腺特异性抗原水平、分期、PPBCs和治疗方式均不能预测生化失败时间。按PPBCs分层时，两种治疗方式的无生化失败生存率均无显著差异。
对于低危前列腺癌患者，无论PPBCs所估计的肿瘤体积如何，近距离放疗和3D-CRT仍然是很好的治疗选择。需要更长时间的随访以及纳入更多疾病体积较大（PPBCs>50%）的男性患者来证实这些初步发现。
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