Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Cancer. 2010 Feb 1;116(3):610-5. doi: 10.1002/cncr.24818.
Some men with a postradiation therapy (RT) prostate-specific antigen (PSA) recurrence will die of noncancer causes before developing metastases. Therefore, our ability to determine who would benefit from salvage hormonotherapy (HT) would be enhanced if an individual's risk of nonprostate-cancer-specific mortality were known.
Among 206 men with unfavorable-risk localized prostate cancer initially randomized to RT+/-HT, 87 men who experienced PSA recurrence were studied. Fine and Gray's competing risks regression was used to assess whether body mass index (BMI) and the Adult Comorbidity Evaluation-27 comorbidity level at randomization were associated with the risk of nonprostate-cancer-specific mortality after PSA recurrence, adjusting for age at recurrence.
After a median postrecurrence follow-up of 4.4 years, moderate/severe comorbidity (adjusted hazard ratio [HR] = 3.15; P = .02), BMI > or = median (27.4 kg/m2; adjusted HR=2.98; p=.04), and increasing age at recurrence (adjusted HR = 1.17; P = .03) were significantly associated with an increased risk of nonprostate-cancer-specific mortality. Five-year cumulative incidence estimates of nonprostate-cancer-specific mortality were as follows: 0% (95% confidence interval [CI] [0,0]) for low-risk patients (mild/no comorbidity and age<median [76.2 years] and BMI<median), 18.8% (5.8-31.8) for intermediate-risk patients (mild/no comorbidity and either age > or = median or BMI > or = median); and 37.9% (95% CI, 6.8-68.9) for high-risk patients (moderate/severe comorbidity; P = .03 overall).
After a post-RT PSA recurrence, men with moderate/severe comorbidity and those who are obese or older face a substantial risk of nonprostate-cancer-specific mortality, and they could be considered for surveillance protocols with a plan to initiate salvage HT if the PSA rises rapidly (eg, PSA doubling time <6 months) or the patient develops clinically or radiographically evident disease.
一些接受放疗后前列腺特异抗原（PSA）复发的患者，在发生转移之前会因非癌症原因死亡。因此，如果能够了解个体非前列腺癌特异性死亡的风险，我们就能更准确地判断哪些患者将从挽救性激素治疗（HT）中获益。
在 206 例最初接受放疗+/-HT 的局部前列腺癌低危患者中，有 87 例患者出现 PSA 复发。采用 Fine-Gray 竞争风险回归分析，评估 PSA 复发后，患者的体质指数（BMI）和随机时的成人合并症评估-27 合并症评分与非前列腺癌特异性死亡风险之间的关系，校正复发时的年龄。
在 PSA 复发后中位随访 4.4 年后，中重度合并症（校正风险比[HR] = 3.15；P =.02）、BMI≥中位数（27.4kg/m2；校正 HR=2.98；P=.04）和复发时年龄增加（校正 HR = 1.17；P =.03）与非前列腺癌特异性死亡风险增加显著相关。非前列腺癌特异性死亡率的 5 年累积发生率估计值如下：低危患者（无合并症和年龄<中位数[76.2 岁]且 BMI<中位数）为 0%（95%置信区间[CI] [0，0]），中危患者（无合并症和年龄≥中位数或 BMI≥中位数）为 18.8%（5.8-31.8），高危患者（中重度合并症；P =.03 总体）为 37.9%（95% CI，6.8-68.9）。
在接受放疗后 PSA 复发后，中重度合并症和肥胖或高龄的患者面临着较高的非前列腺癌特异性死亡风险，如果 PSA 迅速升高（例如 PSA 倍增时间<6 个月）或患者出现临床或影像学可见的疾病，他们可以考虑进行监测方案，并计划启动挽救性 HT。
