Department of Urology, Cipto Mangunkusumo Hospital, University of Indonesia Faculty of Medicine, Jakarta, Indonesia.
Prostate Int. 2013;1(1):16-22. doi: 10.12954/PI.12012. Epub 2013 Feb 4.
Presently there is no published data on the outcomes of localized or locally-advanced prostate cancer (PCa) treated by external-beam radiotherapy (RT) in Indonesia.
This study retrospectively analyzed 96 patients with localized or locally-advanced PCa treated by RT from year 1995 to 2009, at the national referral hospital and the national cancer hospital of Indonesia. Cumulative prostate and pelvic radiation dose/type was <70 Gy conventional RT in 84.4% patients, and ≥70 Gy Three dimensional-conformal or intensity modulated RT in 15.6% patients. Overall survival (OS) and biochemical progression-free survival (BFS) were estimated by Kaplan-Meier. Predictors of OS and biochemical recurrence were analyzed by multivariate Cox regressions.
The median follow-up was 61 months (range, 24 to 169 months). There were 3.1% low-risk, 26% intermediate-risk, and 70.8% high-risk cases. More than half of the patients (52.1%) had pretreatment prostate-specific antigen (PSA) >20 ng/mL. The 5-year survival outcome of low-risk, intermediate-risk, and high-risk patients were: OS, 100%, 94.7%, and 67.9% (P=0.297); and BFS, 100%, 94.1%, and 57.1% (P=0.016), respectively. In the high-risk group, the 5-year OS was 88.3% in patients who received adjuvant hormonal androgen deprivation therapy (HT), compared to 53% in RT only, P=0.08. Significant predictors of OS include high-risk group (hazard Ratio [HR], 9.35; 95% confidence interval [CI], 1.52 to 57.6; P=0.016), adjuvant therapy (HR, 0.175; 95% CI, 0.05 to 0.58; P=0.005), detection by transurethral resection of the prostate (TUR-P) (HR, 6.81; 95% CI, 2.28 to 20.33; P=0.001), and pretreatment PSA (HR, 1.003; 95% CI, 1.00 to 1.005; P=0.039). The sole predictor of biochemical failure was pretreatment PSA (P=0.04), with odds ratio of 4.52 (95% CI, 1.61 to 12.65) for PSA >20 ng/mL.
RT is an effective treatment modality for localized or locally-advanced PCa in Indonesian patients, with outcomes and predictors consistent to that reported elsewhere. Predictors of poorer outcomes include high-risk group, higher pretreatment PSA, incidental detection by TUR-P, and lack of adjuvant HT. Adjuvant hormonal therapy significantly improve the survival of high risk patients.
目前，印度尼西亚尚无关于局部或局部晚期前列腺癌（PCa）接受外照射放疗（RT）治疗的结局的发表数据。
本研究回顾性分析了 1995 年至 2009 年在印度尼西亚国家转诊医院和国家癌症医院接受 RT 治疗的 96 例局部或局部晚期 PCa 患者。84.4%的患者累积前列腺和盆腔放疗剂量/类型<70Gy 常规 RT，15.6%的患者累积前列腺和盆腔放疗剂量/类型≥70Gy 三维适形或调强 RT。采用 Kaplan-Meier 法估计总生存（OS）和生化无进展生存（BFS）。采用多变量 Cox 回归分析 OS 和生化复发的预测因素。
中位随访时间为 61 个月（范围，24 至 169 个月）。低危组占 3.1%，中危组占 26%，高危组占 70.8%。超过一半的患者（52.1%）治疗前前列腺特异性抗原（PSA）>20ng/ml。低危、中危和高危患者的 5 年生存结果为：OS，100%、94.7%和 67.9%（P=0.297）；BFS，100%、94.1%和 57.1%（P=0.016）。高危组中，接受辅助激素雄激素剥夺治疗（HT）的患者 5 年 OS 为 88.3%，而仅接受 RT 的患者为 53%，P=0.08。OS 的显著预测因素包括高危组（风险比[HR]，9.35；95%置信区间[CI]，1.52 至 57.6；P=0.016）、辅助治疗（HR，0.175；95%CI，0.05 至 0.58；P=0.005）、经尿道前列腺切除术（TUR-P）检测（HR，6.81；95%CI，2.28 至 20.33；P=0.001）和治疗前 PSA（HR，1.003；95%CI，1.00 至 1.005；P=0.039）。生化失败的唯一预测因素是治疗前 PSA（P=0.04），PSA>20ng/ml 的 OR 值为 4.52（95%CI，1.61 至 12.65）。
RT 是印度尼西亚局部或局部晚期 PCa 的有效治疗方法，其结果和预测因素与其他地方报道的一致。预后较差的预测因素包括高危组、较高的治疗前 PSA、偶然通过 TUR-P 检测到以及缺乏辅助 HT。辅助激素治疗可显著提高高危患者的生存率。
