前列腺癌风险评估 (CAPRA) 在接受外照射治疗的患者中的应用：高复发风险患者的评估和优化。

The Cancer of the Prostate Risk Assessment (CAPRA) in patients treated with external beam radiation therapy: evaluation and optimization in patients at higher risk of relapse.

机构信息

The University of Michigan, Ann Arbor, MI, USA.

出版信息

Radiother Oncol. 2011 Dec;101(3):513-20. doi: 10.1016/j.radonc.2011.05.080. Epub 2011 Jun 22.

DOI:10.1016/j.radonc.2011.05.080

PMID:21703711

Abstract

BACKGROUND

The Cancer of the Prostate Risk Assessment (CAPRA) was developed to predict freedom from biochemical failure (FFBF) following radical prostatectomy (RP). Its utility following external beam radiation therapy (EBRT) has not been externally evaluated.

METHODS

A retrospective study of 612 patients treated with dose-escalated EBRT at the University of Michigan Medical Center.

RESULTS

Compared to the derivation cohort, EBRT treated patients had higher-risk disease (28% with CAPRA of 6-10 vs. 5%, respectively). A total of 114 patients (19%) had BF with 5-year BF ranging from 7% with CAPRA 0-3 to 35% with CAPRA 7-10. For RT patients the risk of BF at 5-year was similar to 4 surgical cohorts for CAPRA scores 0-2 but lower for all CAPRA scores ≥ 3. The difference favoring RT increased with increasing CAPRA score reaching a 27-50% absolute improved at 5-years for CAPRA scores of 6-10. On multivariate analysis each CAPRA point increased the risk of BF (p<0.0001) while Gleason pattern 5 in the biopsy also increased BF (p=0.01) and long-term androgen deprivation therapy (ADT) significantly reduced the risk of BF (p=0.015).

CONCLUSIONS

Compared to surgical series the risk of BF was lower with dose-escalated EBRT with the greatest difference at the highest CAPRA scores.

摘要

背景

前列腺癌风险评估（CAPRA）旨在预测根治性前列腺切除术（RP）后生化无复发生存率（FFBF）。尚未对其在体外放射治疗（EBRT）后的应用进行外部评估。

方法

对密歇根大学医疗中心接受剂量递增 EBRT 治疗的 612 例患者进行回顾性研究。

结果

与推导队列相比，EBRT 治疗患者具有更高风险的疾病（28%的 CAPRA 为 6-10，而分别为 5%）。共有 114 例患者（19%）发生 BF，5 年 BF 范围为 CAPRA 0-3 为 7%至 CAPRA 7-10 为 35%。对于 RT 患者，5 年 BF 的风险与 4 个手术队列的 CAPRA 评分 0-2 相似，但所有 CAPRA 评分≥3 的 BF 风险均较低。这种有利于 RT 的差异随着 CAPRA 评分的增加而增加，对于 CAPRA 评分 6-10，5 年时的绝对改善率为 27-50%。多变量分析显示，每个 CAPRA 点都会增加 BF 的风险（p<0.0001），而活检中 Gleason 模式 5 也会增加 BF（p=0.01），长期雄激素剥夺治疗（ADT）显著降低 BF 的风险（p=0.015）。