Martin Neil E, Chen Ming-Hui, Beard Clair J, Nguyen Paul L, Loffredo Marian J, Renshaw Andrew A, Kantoff Philip W, D'Amico Anthony V
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-I L2 Boston, MA 02115, USA.
Department of Statistics, University of Connecticut, 215 Glenbrook Road, Storrs, CT 06269, USA.
Prostate Cancer. 2014;2014:912943. doi: 10.1155/2014/912943. Epub 2014 Feb 20.
Background and Purpose. Life expectancy data could identify men with favorable post-radiation prostate-specific antigen (PSA) failure kinetics unlikely to require androgen deprivation therapy (ADT). Materials and Methods. Of 206 men with unfavorable-risk prostate cancer in a randomized trial of radiation versus radiation and ADT, 53 experienced a PSA failure and were followed without salvage ADT. Comorbidity, age and established prognostic factors were assessed for relationship to death using Cox regression analyses. Results. The median age at failure, interval to PSA failure, and PSA doubling time were 76.6 years (interquartile range [IQR]: 71.8-79.3), 49.1 months (IQR: 37.7-87.4), and 25 months (IQR: 13.1-42.8), respectively. After a median follow up of 4.0 years following PSA failure, 45% of men had died, none from prostate cancer and no one had developed metastases. Both increasing age at PSA failure (HR: 1.14; 95% CI: 1.03-1.25; P = 0.008) and the presence of moderate to severe comorbidity (HR: 12.5; 95% CI: 3.81-41.0; P < 0.001) were significantly associated with an increased risk of death. Conclusions. Men over the age of 76 with significant comorbidity and a PSA doubling time >2 years following post-radiation PSA failure appear to be good candidates for observation without ADT intervention.
背景与目的。预期寿命数据可识别出前列腺特异性抗原（PSA）放疗后失败动力学良好、不太可能需要雄激素剥夺治疗（ADT）的男性。材料与方法。在一项放疗与放疗联合ADT的随机试验中，206例具有不良风险前列腺癌的男性中，53例经历了PSA失败，且在未进行挽救性ADT的情况下接受随访。使用Cox回归分析评估合并症、年龄和既定预后因素与死亡的关系。结果。失败时的中位年龄、PSA失败间隔时间和PSA倍增时间分别为76.6岁（四分位间距[IQR]：71.8 - 79.3）、49.1个月（IQR：37.7 - 87.4）和25个月（IQR：13.1 - 42.8）。在PSA失败后中位随访4.0年时，45%的男性死亡，均非死于前列腺癌，且无人发生转移。PSA失败时年龄增加（风险比[HR]：1.14；95%置信区间[CI]：1.03 - 1.25；P = 0.008）和存在中度至重度合并症（HR：12.5；95% CI：3.81 - 41.0；P < 0.001）均与死亡风险增加显著相关。结论。放疗后PSA失败后年龄超过76岁、合并症严重且PSA倍增时间>2年的男性似乎是无需ADT干预而进行观察的良好候选者。
