Hamstra Daniel A, Bae Kyounghwa, Hanks Gerald, Hu Chen, Shipley William U, Pan Charlie C, Roach Mack, Lawton Colleen A, Sandler Howard M
Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan.
Cancer. 2015 Mar 15;121(6):844-52. doi: 10.1002/cncr.29146. Epub 2014 Nov 19.
Biochemical failure (BF) after radiation therapy is defined on the basis of a rising prostate-specific antigen (PSA) level (A1 failure) or any event that prompts the initiation of salvage androgen-deprivation therapy without PSA failure (A2). It was hypothesized that A2 failure may have a different prognosis.
Data for 2799 eligible patients from Radiation Therapy Oncology Group (RTOG) 9202 and RTOG 9413 were analyzed. BF was defined according to the 1997 American Society for Therapeutic Radiology and Oncology consensus definition as A1 for PSA failure or as A2 for the start of salvage hormone therapy before 3 consecutive PSA rises.
Rates of all-cause mortality (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.5-2.0; P < .0001) and distant metastasis (DM; HR, 1.6; 95% CI, 1.3-2.0; P < .0001) were greater with A2 failure. The 5-year overall survival (OS) rates were 88.2% and 74.6% for A1 and A2, respectively (P < .0001), and the DM rates were 15.7% and 29.0%, respectively (P < .0001). The DM rate was greater at 5 years for A2 patients with DM as the first sign of failure versus patients with other A2 failures (87.3% vs 11.7%, P < .001), and this also correlated with worse OS at 5 years: 81.1% for A2 failure without DM and 52.8% with DM (P < .001). After the removal of patients with DM, the difference between A1 and A2 BF persisted for OS (P = .002) but not for DM (P = .16) CONCLUSIONS: These results suggest that patients with rising PSA levels alone have less risk than those with A2 failures; although DM was the largest contributor of adverse risk to A2 failure, it did not account for all excess risk in A2 failure.
放射治疗后的生化失败（BF）是根据前列腺特异性抗原（PSA）水平升高（A1失败）或任何促使在无PSA失败的情况下开始挽救性雄激素剥夺治疗的事件（A2）来定义的。据推测，A2失败可能具有不同的预后。
对来自放射治疗肿瘤学组（RTOG）9202和RTOG 9413的2799例符合条件的患者的数据进行了分析。根据1997年美国放射治疗与肿瘤学会的共识定义，BF被定义为PSA失败为A1，或在连续3次PSA升高之前开始挽救性激素治疗为A2。
A2失败患者的全因死亡率（风险比[HR]，1.7；95%置信区间[CI]，1.5 - 2.0；P <.0001）和远处转移（DM；HR，1.6；95% CI，1.3 - 2.0；P <.0001）发生率更高。A1和A2的5年总生存率（OS）分别为88.2%和74.6%（P <.0001），DM发生率分别为15.7%和29.0%（P <.0001）。以DM作为首次失败迹象的A2患者在5年时的DM发生率高于其他A2失败患者（87.3%对11.7%，P <.001），这也与5年时较差的OS相关：无DM的A2失败患者为81.1%，有DM的为52.8%（P <.001）。在剔除有DM的患者后，A1和A2 BF在OS方面的差异仍然存在（P =.002），但在DM方面不存在差异（P =.16）。结论：这些结果表明，仅PSA水平升高的患者比A2失败的患者风险更低；尽管DM是A2失败不良风险的最大贡献因素，但它并未解释A2失败中的所有额外风险。
