Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
American Hospital, Istanbul, Turkey.
Prostate Cancer Prostatic Dis. 2017 Dec;20(4):389-394. doi: 10.1038/pcan.2017.24. Epub 2017 May 2.
Which men benefit most from adding androgen deprivation therapy (ADT) to salvage radiation therapy (SRT) after prostatectomy has not clearly been defined; therefore, we evaluated the impact of ADT to SRT on failure-free survival (FFS) in men with a rising or persistent PSA after prostatectomy.
We identified 332 men who received SRT after prostatectomy from 1987 to 2010. Recursive partitioning analysis (RPA) identified favorable, intermediate and unfavorable groups based on the risk of failure after SRT alone. Kaplan-Meier and log-rank tests compared FFS with and without ADT.
Forty-three percent received SRT alone and 57% received SRT with ADT (median 6.6 months (interquartile range (IQR) 5.8-18.1) ADT). Median SRT dose was 70 Gy (IQR 70-70), and median follow-up after SRT was 6.7 years (IQR 4.5-10.8). On Cox's proportional hazard regression, ADT improved FFS (adjusted hazard ratio 0.60, 95% confidence interval: 0.42-0.86; P=0.006). RPA classified unfavorable disease as negative surgical margins (SMs) and preradiation PSA of ⩾0.5 ng ml. Favorable disease had neither adverse factor, and intermediate disease had one adverse factor. The addition of ADT to SRT improved 5-year FFS for men with unfavorable disease (70.3% vs 23.4%; P<0.001) and intermediate disease (69.8% vs 48.0%; P=0.003), but not for men with favorable disease (81.2% vs 78.0%; P=0.971).
The addition of ADT to SRT appears to improve FFS for men with a preradiation PSA of ⩾0.5 ng ml or with negative SM at prostatectomy. Men with involved surgical margins and PSA <0.5 ng ml appear to be at a lower risk of failure after SRT alone and may not derive as much benefit from the administration of ADT with SRT. These results are hypothesis-generating only, and further prospective data are required to see if ADT can safely be omitted in this select group of men.
在前列腺切除术后，哪些男性从添加雄激素剥夺治疗（ADT）中获益最大尚不清楚，因此，我们评估了 ADT 对前列腺切除术后 PSA 升高或持续升高的患者挽救性放疗（SRT）后无失败生存（FFS）的影响。
我们从 1987 年至 2010 年确定了 332 名接受 SRT 治疗的患者。递归分区分析（RPA）根据单独接受 SRT 后失败的风险，确定了有利、中等和不利的组。Kaplan-Meier 和对数秩检验比较了有和无 ADT 的 FFS。
43%的患者仅接受 SRT，57%的患者接受 SRT 联合 ADT（中位时间 6.6 个月（四分位间距（IQR）5.8-18.1）ADT）。中位 SRT 剂量为 70Gy（IQR 70-70），SRT 后中位随访时间为 6.7 年（IQR 4.5-10.8）。在 Cox 比例风险回归中，ADT 改善了 FFS（调整后的危险比 0.60，95%置信区间：0.42-0.86；P=0.006）。RPA 将不利疾病定义为阴性手术切缘（SMs）和放疗前 PSA ⩾0.5ng/ml。有利疾病无不良因素，中间疾病有一个不良因素。在 SRT 中添加 ADT 可提高不利疾病（70.3% vs 23.4%；P<0.001）和中间疾病（69.8% vs 48.0%；P=0.003）男性的 5 年 FFS，但对有利疾病（81.2% vs 78.0%；P=0.971）男性则没有影响。
在前列腺切除术后 PSA ⩾0.5ng/ml 或 SM 阴性的患者中，在 SRT 中添加 ADT 似乎可提高 FFS。手术切缘受累和 PSA <0.5ng/ml 的男性在接受 SRT 后单独发生失败的风险似乎较低，并且可能不会从 SRT 加 ADT 治疗中获得太大益处。这些结果只是产生假说，需要进一步的前瞻性数据来观察 ADT 是否可以安全地省略在这组特定的男性中。
