根治性前列腺切除术后生化复发后的临床进展长期风险：从手术到复发时间的影响。

Long-term risk of clinical progression after biochemical recurrence following radical prostatectomy: the impact of time from surgery to recurrence.

机构信息

Department of Urology, Mayo Clinic, Rochester, MN, USA.

出版信息

Eur Urol. 2011 Jun;59(6):893-9. doi: 10.1016/j.eururo.2011.02.026. Epub 2011 Feb 22.

DOI:10.1016/j.eururo.2011.02.026

PMID:21388736

Abstract

BACKGROUND

The natural history of biochemical recurrence (BCR) after radical retropubic prostatectomy (RRP) is variable and does not always translate into systemic progression or prostate cancer (PCa) death.

OBJECTIVE

To evaluate long-term clinical outcomes of patients with BCR and to determine predictors of disease progression and mortality in these men.

DESIGN, SETTING, AND PARTICIPANTS: We reviewed our institutional registry of 14 632 patients who underwent RRP between 1990 and 2006 to identify 2426 men with BCR (prostate-specific antigen [PSA] levels ≥ 0.4 ng/ml) who did not receive neoadjuvant or adjuvant therapy. Median follow-up was 11.5 yr after RRP and 6.6 yr after BCR.

INTERVENTION

RRP.

MEASUREMENTS

Patients were grouped into quartiles according to time from RRP to BCR. Survival after BCR was estimated using the Kaplan-Meier method and compared using the log-rank test. Cox proportional hazard regression models were used to analyze clinicopathologic variables associated with systemic progression and death from PCa.

RESULTS AND LIMITATIONS

Median systemic progression-free survival (PFS) and cancer-specific survival (CSS) had not been reached after 15 yr of follow-up after BCR. Cancer-specific mortality 10 yr after BCR was 9.9%, 9.3%, 7.8%, and 4.7% for patients who experienced BCR <1.2 yr, 1.2-3.1 yr, 3.1-5.9 yr, and >5.9 yr after RRP, respectively (p=0.10). On multivariate analysis, time from RRP to BCR was not significantly associated with the risk of systemic progression (p=0.50) or cancer-specific mortality (p=0.81). Older patient age, increased pathologic Gleason score, advanced tumor stage, and rapid PSA doubling time (DT) predicted systemic progression and death from PCa. Limitations included retrospective design, varied utilization of salvage therapies, and the inclusion of few patients with positive lymph nodes.

CONCLUSIONS

Only a minority of men experience systemic progression and death from PCa following BCR. The decision to institute secondary therapies must balance the risk of disease progression with the cost and morbidity of treatment, independent of time from RRP to BCR.

摘要

背景

根治性前列腺切除术（RRP）后生化复发（BCR）的自然史是多变的，并不总是转化为全身进展或前列腺癌（PCa）死亡。

目的

评估 BCR 患者的长期临床结局，并确定这些男性疾病进展和死亡的预测因素。

设计、地点和参与者：我们回顾了我们机构 1990 年至 2006 年间接受 RRP 的 14632 名患者的登记处，以确定 2426 名 BCR 患者（前列腺特异性抗原 [PSA]水平≥0.4ng/ml），他们未接受新辅助或辅助治疗。RRP 后中位随访 11.5 年，BCR 后中位随访 6.6 年。

干预措施

RRP。

测量

根据 RRP 至 BCR 的时间，患者被分为四组。使用 Kaplan-Meier 方法估计 BCR 后的生存情况，并使用对数秩检验进行比较。Cox 比例风险回归模型用于分析与全身进展和 PCa 死亡相关的临床病理变量。

结果和局限性

BCR 后 15 年随访时，中位全身无进展生存（PFS）和癌症特异性生存（CSS）尚未达到。BCR 后 10 年的癌症特异性死亡率分别为 BCR<1.2 年、1.2-3.1 年、3.1-5.9 年和>5.9 年的患者为 9.9%、9.3%、7.8%和 4.7%（p=0.10）。多变量分析显示，从 RRP 到 BCR 的时间与全身进展的风险无显著相关性（p=0.50）或癌症特异性死亡率（p=0.81）。患者年龄较大、病理 Gleason 评分升高、肿瘤分期较晚和 PSA 倍增时间（DT）较快预测全身进展和 PCa 死亡。局限性包括回顾性设计、挽救性治疗的使用存在差异以及少数淋巴结阳性患者的纳入。