Ko Eric C, Liu Jerry T, Stone Nelson N, Stock Richard G
Department of Radiation Oncology, Mount Sinai Medical Center, New York, United States.
Department of Radiation Oncology, Mount Sinai Medical Center, New York, United States; Department of Urology, Mount Sinai Medical Center, New York, United States.
Radiother Oncol. 2014 Feb;110(2):261-7. doi: 10.1016/j.radonc.2013.11.003. Epub 2013 Nov 30.
We investigated whether earlier PSA failure following prostate brachytherapy is associated with increased rates of distant metastases (DM), prostate cancer-specific mortality (PCSM), and overall mortality.
We retrospectively analyzed 2818 patients who underwent brachytherapy ± external beam radiation therapy (EBRT) ± androgen deprivation therapy (ADT). With median follow-up of 5.52 years, 264 patients experienced PSA failure at a median time of 3.25 years. Patients were stratified to early vs. late PSA failures at cutoffs of 1.5 years, 3 years, or 5 years, and tested in univariate/multivariate analyses for freedom from DM, cause-specific survival (CSS), and overall survival (OS).
Among patients with PSA failures, 69 (26%) patients experienced DM, 47 (18%) PCSM, and 56 (21%) deaths from other causes. Patients with rapid PSA failures demonstrated increased rates of DM, PCSM, and overall mortality, despite higher total BED and longer ADT. In multivariate analysis with a PSA failure interval <3 years, the hazard ratio (HR) for DM was 3.92 (95% CI: 2.34-6.55; p=0.000); HR for PCSM was 2.79 (95% CI: 1.45-5.38; p=0.002); and HR for overall mortality was 2.28 (95% CI: 1.50-3.48; p=0.000).
Early PSA failure following radiation is a poor prognostic factor, as it is associated with increased DM, PCSM, and overall mortality.
我们研究了前列腺近距离放射治疗后早期前列腺特异性抗原（PSA）失败是否与远处转移（DM）、前列腺癌特异性死亡率（PCSM）和总死亡率的增加相关。
我们回顾性分析了2818例接受近距离放射治疗±外照射放疗（EBRT）±雄激素剥夺治疗（ADT）的患者。中位随访时间为5.52年，264例患者在中位时间3.25年时出现PSA失败。患者按1.5年、3年或5年的临界值分层为早期与晚期PSA失败，并在单因素/多因素分析中检测无DM、病因特异性生存（CSS）和总生存（OS）情况。
在出现PSA失败的患者中，69例（26%）发生DM，47例（18%）PCSM，56例（2１%）死于其他原因。尽管总生物等效剂量更高且ADT时间更长，但PSA快速失败的患者DM、PCSM和总死亡率的发生率仍有所增加。在PSA失败间隔<3年的多因素分析中，DM的风险比（HR）为3.92（95%置信区间：2.34-6.55；p=0.000）；PCSM的HR为2.79（95%置信区间：1.45-5.38；p=0.002）；总死亡率的HR为2.28（95%置信区间：1.50-3.48；p=0.000）。
放疗后早期PSA失败是一个不良预后因素，因为它与DM、PCSM和总死亡率的增加相关。
