Algarra Rubén, Hevia Mateo, Tienza Antonio, Merino Imanol, Velis José María, Zudaire Javier, Robles José Enrique, Pascual Ignacio
Department of Urology, University of Navarra Clinic, Navarra, Spain.
Can Urol Assoc J. 2014 May;8(5-6):E333-41. doi: 10.5489/cuaj.1665.
We evaluate the prognosis of patients with biochemical recurrence (BCR) treated with androgen deprivation therapy (ADT) and to determine the influential factors to castration resistance (CR) and death.
From a series of 1310 patients with T1-T2 prostate cancer treated with radical prostatectomy between 1989 and 2012, 371 had BCR. Patients with lymph node involvement were excluded. We analyzed only the 159 treated with salvage ADT. At the end of the study, 77 (48%) had developed CR.
The median follow-up to CR was 9.2 years. The CR-resistant free survival (RFS) was 76 ± 3%, 62 ± 3% and 43 ± 9% in 5, 10 and 15 years, respectively. The RFS median time was 14 years. In the multivariate study, the prostate-specific antigen (PSA) doubling time (PSA-DT) was <6 months (p = 0.01) (hazard ratio [HR] 3; 95% confidence interval [CI] 1.4-6.8, p = 0.007); seminal vesicle involvement (HR 3.1; 95% CI 1.5-6.2, p = 0.01) and PSA velocity in ng/mL/year (HR 1.3; 95% CI 1.1-1.5, p = 0.002) with better cut-off points of 0.84 ng/mL/year (p = 0.04) (HR 4; 95% CI 1.7-9.4, p = 0.001) were influential variables. Specific survival (SS) at 5, 10 and 15 years since surgery was 96 ± 1, 85 ± 2 and 76 ± 4, respectively. The time of CR to death was 30 ± 6% at 5 years, with the median at 3.2 years. In the multivariate only Ki 67 (HR 1.04; 95% CI 1.005-1.08, p = 0.02) had an independent influence.
In BCR patients treated with ADT, the median to CR was 14 years. PSA-DT <6 months, PSA velocity (ng/mL/year) and seminal vesicle involvement were influential variables. From the CR, the median time to death was 3.2 years. Ki-67 marker was an independent influence.
我们评估接受雄激素剥夺疗法（ADT）治疗的生化复发（BCR）患者的预后，并确定去势抵抗（CR）和死亡的影响因素。
在1989年至2012年间接受根治性前列腺切除术治疗的1310例T1 - T2期前列腺癌患者中，371例出现BCR。排除有淋巴结转移的患者。我们仅分析了159例接受挽救性ADT治疗的患者。研究结束时，77例（48%）出现CR。
至CR的中位随访时间为9.2年。5年、10年和15年的CR无进展生存期（RFS）分别为76±3%、62±3%和43±9%。RFS的中位时间为14年。在多变量研究中，前列腺特异性抗原（PSA）倍增时间（PSA - DT）<6个月（p = 0.01）（风险比[HR] 3；95%置信区间[CI] 1.4 - 6.8，p = 0.007）；精囊受累（HR 3.1；95% CI 1.5 - 6.2，p = 0.01）以及以每年0.84 ng/mL为更佳切点的PSA速度（ng/mL/年）（HR 1.3；95% CI 1.1 - 1.5，p = 0.002）（HR 4；95% CI 1.7 - 9.4，p = 0.001）是有影响的变量。术后5年、10年和15年的特定生存期（SS）分别为96±1、85±2和76±4。从CR到死亡的5年时间为30±6%，中位时间为3.2年。在多变量分析中，只有Ki 67（HR 1.04；95% CI 1.005 - 1.08，p = 0.02）有独立影响。
在接受ADT治疗的BCR患者中，至CR的中位时间为14年。PSA - DT<6个月、PSA速度（ng/mL/年）和精囊受累是有影响的变量。从CR开始，至死亡的中位时间为3.2年。Ki - 67标志物有独立影响。
