Prostate Cancer Research Program, Sidney Kimmel Comprehensive Cancer Center, Brady Urological Institute, Johns Hopkins University, Baltimore, MD 21231, USA.
BJU Int. 2012 Jan;109(1):32-9. doi: 10.1111/j.1464-410X.2011.10422.x. Epub 2011 Jul 20.
To describe metastasis-free survival (MFS) in men with prostate-specific antigen (PSA) recurrence following radical prostatectomy, and to define clinical prognostic factors modifying metastatic risk.
We conducted a retrospective analysis of 450 men treated with prostatectomy at a tertiary hospital between July 1981 and July 2010 who developed PSA recurrence (≥0.2 ng/mL) and never received adjuvant or salvage therapy before the development of metastatic disease. We estimated MFS using the Kaplan-Meier method, and investigated factors influencing the risk of metastasis using Cox proportional hazards regression.
Median follow-up after prostatectomy was 8.0 years, and after biochemical recurrence was 4.0 years. At last follow-up, 134 of 450 patients (29.8%) had developed metastases, while median MFS was 10.0 years. Using multivariable regressions, two variables emerged as independently predictive of MFS: PSA doubling time (<3.0 vs 3.0-8.9 vs 9.0-14.9 vs ≥15.0 months) and Gleason score (≤6 vs 7 vs 8-10). Using these stratifications of Gleason score and PSA doubling time, tables were constructed to predict median, 5- and 10-year MFS after PSA recurrence. In different patient subsets, median MFS ranged from 1 to 15 years.
In men undergoing prostatectomy, MFS after PSA recurrence is variable and is most strongly influenced by PSA doubling time and Gleason score. These parameters serve to stratify men into different risk groups with respect to metastatic progression. Our findings may provide the background for appropriate selection of patients, treatments and endpoints for clinical trials.
描述根治性前列腺切除术后 PSA 复发患者的无转移生存（MFS），并定义改变转移风险的临床预后因素。
我们对 1981 年 7 月至 2010 年 7 月在一家三级医院接受前列腺切除术且在发生转移性疾病之前从未接受过辅助或挽救性治疗的 450 例 PSA 复发（≥0.2ng/ml）的患者进行了回顾性分析。我们使用 Kaplan-Meier 方法估计 MFS，并使用 Cox 比例风险回归分析影响转移风险的因素。
前列腺切除术后中位随访时间为 8.0 年，生化复发后为 4.0 年。在最后一次随访时，450 例患者中有 134 例（29.8%）发生了转移，而中位 MFS 为 10.0 年。多变量回归分析显示，两个变量独立预测 MFS：PSA 倍增时间（<3.0 与 3.0-8.9 与 9.0-14.9 与≥15.0 个月）和 Gleason 评分（≤6 与 7 与 8-10）。使用这些 Gleason 评分和 PSA 倍增时间分层，构建了预测 PSA 复发后中位、5 年和 10 年 MFS 的表格。在不同的患者亚组中，中位 MFS 范围从 1 年到 15 年不等。
在接受前列腺切除术的患者中，PSA 复发后的 MFS 是可变的，最受 PSA 倍增时间和 Gleason 评分的影响。这些参数可将患者分为不同的风险组，与转移进展相关。我们的发现可为临床试验中适当选择患者、治疗方法和终点提供背景。
