Departments of Radiation Oncology, Medical Physics, and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Eur Urol. 2011 Dec;60(6):1133-9. doi: 10.1016/j.eururo.2011.08.029. Epub 2011 Aug 22.
Higher radiation dose levels have been shown to be associated with improved tumor-control outcomes in localized prostate cancer (PCa) patients.
Identify predictors of biochemical tumor control and distant metastases-free survival (DMFS) outcomes for patients with clinically localized PCa treated with conformal external-beam radiotherapy (RT) as well as present an updated nomogram predicting long-term biochemical tumor control after RT.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective analysis comprised 2551 patients with clinical stages T1-T3 PCa. Median follow-up was 8 yr, extending >20 yr.
Prescription doses ranged from 64.8 to 86.4 Gy. A total of 1249 patients (49%) were treated with neoadjuvant and concurrent androgen-deprivation therapy (ADT); median duration of ADT was 6 mo.
A proportional hazards regression model predicting the probability of biochemical relapse and distant metastases after RT included pretreatment prostate-specific antigen (PSA) level, clinical stage, biopsy Gleason sum, ADT use, and radiation dose. A nomogram predicting the probability of biochemical relapse after RT was developed.
Radiation dose was one of the important predictors of long-term biochemical tumor control. Dose levels < 70.2 Gy and 70.2-79.2 Gy were associated with 2.3- and 1.3-fold increased risks of PSA relapse compared with higher doses. Improved PSA relapse-free survival (PSA-RFS) outcomes with higher doses were observed for all risk groups. Use of ADT, especially for intermediate- and high-risk patients, was associated with significantly improved biochemical tumor-control outcomes. A nomogram predicting PSA-RFS was generated and was associated with a concordance index of 0.67. T stage, Gleason score, pretreatment PSA, ADT use, and higher radiation doses were also noted to be significant predictors of improved DMFS outcomes.
Higher radiation dose levels were consistently associated with improved biochemical control outcomes and reduction in distant metastases. The use of short-course ADT in conjunction with RT improved long-term PSA-RFS and DMFS in intermediate- and high-risk patients; however, an overall survival advantage was not observed.
较高的辐射剂量水平已被证明与局限性前列腺癌（PCa）患者肿瘤控制结果的改善有关。
确定接受适形外照射放疗（RT）治疗的局限性 PCa 患者的生化肿瘤控制和远处转移无复发生存（DMFS）结果的预测指标，并提供一个预测 RT 后长期生化肿瘤控制的更新列线图。
设计、设置和参与者：这项回顾性分析包括 2551 例临床分期为 T1-T3 的 PCa 患者。中位随访时间为 8 年，最长随访时间超过 20 年。
处方剂量范围为 64.8 至 86.4 Gy。共有 1249 例（49%）患者接受新辅助和同期雄激素剥夺治疗（ADT）；ADT 的中位持续时间为 6 个月。
用于预测 RT 后生化复发和远处转移概率的比例风险回归模型包括治疗前前列腺特异性抗原（PSA）水平、临床分期、活检 Gleason 总和、ADT 使用和辐射剂量。开发了一个预测 RT 后生化复发概率的列线图。
辐射剂量是长期生化肿瘤控制的重要预测因素之一。与高剂量相比，剂量<70.2 Gy 和 70.2-79.2 Gy 与 PSA 复发风险增加 2.3 倍和 1.3 倍相关。所有风险组均观察到较高剂量的 PSA 无复发生存（PSA-RFS）改善。ADT 的使用，特别是在中危和高危患者中，与显著改善的生化肿瘤控制结果相关。生成了一个预测 PSA-RFS 的列线图，其一致性指数为 0.67。T 分期、Gleason 评分、治疗前 PSA、ADT 使用和较高的辐射剂量也被认为是改善 DMFS 结果的重要预测因素。
较高的辐射剂量水平与生化控制结果的改善和远处转移的减少有关。在 RT 中联合使用短期 ADT 可改善中高危患者的长期 PSA-RFS 和 DMFS，但未观察到总生存优势。
