Delouya Guila, Krishnan Vimal, Bahary Jean-Paul, Larrivée Sandra, Taussky Daniel
Department of Radiation Oncology, Hôpital Notre-Dame, Center Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada; University of Montreal Hospital Research Centre, Montreal, Canada.
Department of Radiation Oncology, Hôpital Notre-Dame, Center Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
Urology. 2014 Sep;84(3):629-33. doi: 10.1016/j.urology.2014.05.032.
To analyze the value of the Cancer of the Prostate Risk Assessment (CAPRA) score to predict biochemical failure (bF) in patients with D'Amico low- or intermediate-risk prostate cancer treated with different radiation techniques.
We analyzed 744 patients treated with either external beam radiotherapy (52.7%) or permanent-seed prostate brachytherapy (47.3%) without any androgen deprivation. External beam radiotherapy dose levels were extreme hypofractionation (45 Gy in 9 fractions) in 10%, 76-79.2 Gy (in 1.8-2.0 Gy per fraction) in 32.7%, and 70.2-74 Gy in 10%. All patients had a minimum of 36-month follow-up. Cox regression analysis was used for univariate and multivariate analysis to predict for bF, as per the Phoenix definition (prostate-specific antigen-nadir + 2 ng/mL).
Median follow-up for patients without bF was 56 months (range, 36-114 months). In univariate analysis, CAPRA score as a continuous variable was predictive of bF (hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.23-1.79; P <.001), and in multivariate analysis adjusted for treatment type, the HR was 1.39 (95% CI, 1.14-1.71; P = .002). D'Amico intermediate-risk vs low-risk patients had an HR for bF of 1.93 (95% CI, 1.07-3.47; P = .029) in univariate analysis, but the difference was not statistically significant anymore after adjustment for treatment type, (P = .206). The area under the curve of the CAPRA score as a continuous variable at 3 and 5 years was 0.66 and 0.62, respectively (P = .005 for both years).
The CAPRA score is predictive of bF. Each 1-point rise increased the risk of bF by 39%, which is comparable to surgical series.
分析前列腺癌风险评估（CAPRA）评分对接受不同放疗技术治疗的达米科低危或中危前列腺癌患者生化复发（bF）的预测价值。
我们分析了744例接受外照射放疗（52.7%）或永久性前列腺近距离放疗（47.3%）且未接受任何雄激素剥夺治疗的患者。外照射放疗剂量水平分别为：10%的患者采用超分割放疗（9次分割，共45 Gy），32.7%的患者接受76 - 79.2 Gy（每次分割1.8 - 2.0 Gy），10%的患者接受70.2 - 74 Gy。所有患者至少随访36个月。按照Phoenix定义（前列腺特异性抗原最低点 + 2 ng/mL），采用Cox回归分析进行单因素和多因素分析以预测bF。
无bF患者的中位随访时间为56个月（范围36 - 114个月）。在单因素分析中，CAPRA评分作为连续变量可预测bF（风险比[HR]，1.49；95%置信区间[CI]，1.23 - 1.79；P <.001），在多因素分析中，校正治疗类型后，HR为1.39（95% CI，1.14 - 1.71；P =.002）。在单因素分析中，达米科中危与低危患者bF的HR为1.93（95% CI，1.07 - 3.47；P =.029），但校正治疗类型后差异不再具有统计学意义（P =.206）。CAPRA评分作为连续变量在第3年和第5年的曲线下面积分别为0.66和0.62（两年P值均为.005）。
CAPRA评分可预测bF。评分每升高1分，bF风险增加39%，这与手术系列研究结果相当。
