Radiation Oncology, San Giovanni Battista Hospital, University of Torino, 10126 Turin, Italy.
J Cancer Res Clin Oncol. 2013 Jul;139(7):1141-7. doi: 10.1007/s00432-013-1426-0. Epub 2013 Apr 4.
Purpose of this study is to analyze outcomes and pre-treatment prognostic factors in high-risk prostate cancer patients with initial PSA ≥ 20 ng/mL, treated with high-dose external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT) in a single institution.
Between March 2003 and December 2011, 155 consecutive high-risk prostate cancer patients (a) presenting with pre-treatment PSA level ≥ 20 ng/mL, (b) treated with definitive EBRT, and (c) with a minimum follow-up of 24 months were included in this retrospective analysis. Phoenix definition was used to define biochemical control. Primary endpoints were as follows: biochemical disease-free survival (bDFS), distant metastasis-free survival (DMFS), cancer-specific survival (CSS) and overall survival (OS). Multivariate analysis was performed to determine the independent prognostic impact of pre-treatment clinical factors [T stage, PSA, and Gleason score (GS)].
At a median follow-up time of 62 months, actuarial bDFS, DMFS, CSS, and OS at 5 years were 64.8, 85.2, 95.8, and 94.4 %, respectively. On multivariate analysis, only GS was significantly associated with three clinical endpoints (bDFS: HR 1.6; p = 0.022, CSS: HR 4.27, p = 0.044, OS: HR 2.6; p = 0.038). Pre-treatment zenith PSA was associated only with bDFS (HR 1.87; p = 0.027).
Patients with "high" PSA levels (≥ 20 ng/mL) showed favorable clinical outcomes, supporting the role of local radiotherapy as primary therapy in combination with long-term ADT in patients with high PSA levels at diagnosis. A GS of 8-10 is the strongest predictor of outcome.
本研究旨在分析单中心 155 例初始 PSA≥20ng/ml 的高危前列腺癌患者接受高剂量外照射放疗（EBRT）和雄激素剥夺治疗（ADT）的治疗结果和治疗前预后因素。
2003 年 3 月至 2011 年 12 月，连续 155 例高危前列腺癌患者（a）初诊时 PSA 水平≥20ng/ml，（b）接受根治性 EBRT，（c）随访时间≥24 个月，纳入本回顾性分析。采用凤凰标准定义生化无复发生存（bDFS）。主要终点如下：生化无病生存（bDFS）、远处转移无复发生存（DMFS）、癌症特异性生存（CSS）和总生存（OS）。采用多变量分析确定治疗前临床因素（T 分期、PSA 和 Gleason 评分（GS））对预后的独立影响。
中位随访时间为 62 个月时，5 年时的 bDFS、DMFS、CSS 和 OS 分别为 64.8%、85.2%、95.8%和 94.4%。多变量分析显示，只有 GS 与三个临床终点显著相关（bDFS：HR 1.6；p=0.022，CSS：HR 4.27，p=0.044，OS：HR 2.6；p=0.038）。治疗前 zenith PSA 仅与 bDFS 相关（HR 1.87；p=0.027）。
“高”PSA 水平（≥20ng/ml）的患者临床结局良好，支持局部放疗作为主要治疗手段，联合诊断时 PSA 水平较高的患者长期 ADT。GS 为 8-10 是预测结局的最强因素。
