Tomita Natsuo, Soga Norihito, Ogura Yuji, Kageyama Takumi, Kodaira Takeshi
Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan.
Asia Pac J Clin Oncol. 2017 Jun;13(3):145-151. doi: 10.1111/ajco.12664. Epub 2017 Jan 25.
The definition of very high-risk (VHR) prostate cancer is currently based on the study of radical prostatectomy. We aimed to identify a suitable definition for VHR group following external beam radiation therapy (EBRT) and long-term androgen-deprivation therapy (ADT).
This retrospective study included 356 high-risk patients treated with EBRT and long-term ADT. A median follow-up time was 68 months. At first, associations of previously described prognostic factors with biochemical disease-free survival (bDFS), clinical relapse-free survival (cRFS) and prostate cancer-specific survival (CSS) were examined. Second, the combination of significant adverse factors in the first analysis served as VHR test definitions. For each factor, a Cox proportional hazards model was used to calculate their hazard ratios for bDFS and cRFS. The logrank test was used to evaluate the association between each factor and CSS.
Primary Gleason pattern 5, T4 and ≥ 5 or 4 cores with Gleason score 8-10 were risk factors associated with bDFS, cRFS and CSS. Eleven VHR test definitions composed of these adverse factors were associated significantly with bDFS, cRFS and CSS. The final definition was described by primary Gleason pattern 5 or T4 or ≥ 4 cores with Gleason score 8-10 because of the largest sample size of 38% among 11 test definitions. bDFS, cRFS and CSS of the VHR group were significantly lower compared with other high-risk patients (P < 0.001, P < 0.001 and P = 0.015, respectively).
These VHR criteria were best fitted following EBRT with long-term ADT.
目前，极高风险（VHR）前列腺癌的定义是基于根治性前列腺切除术的研究。我们旨在确定适用于外照射放疗（EBRT）和长期雄激素剥夺治疗（ADT）后VHR组的定义。
这项回顾性研究纳入了356例接受EBRT和长期ADT治疗的高危患者。中位随访时间为68个月。首先，研究先前描述的预后因素与无生化疾病生存（bDFS）、无临床复发生存（cRFS）和前列腺癌特异性生存（CSS）之间的关联。其次，第一次分析中显著不良因素的组合作为VHR测试定义。对于每个因素，使用Cox比例风险模型计算其bDFS和cRFS的风险比。使用对数秩检验评估每个因素与CSS之间的关联。
主要Gleason分级模式5、T4以及Gleason评分8 - 10的≥5个或4个癌灶是与bDFS、cRFS和CSS相关的危险因素。由这些不良因素组成的11种VHR测试定义与bDFS、cRFS和CSS显著相关。最终定义为主要Gleason分级模式5或T4或Gleason评分8 - 10的≥4个癌灶，因为在11种测试定义中其样本量最大，为38%。VHR组的bDFS、cRFS和CSS与其他高危患者相比显著更低（分别为P < 0.001、P < 0.001和P = 0.015）。
这些VHR标准最适用于接受长期ADT的EBRT后情况。
