Luo Y, Li M C, Qi H Z, Zhao J H, Han Y L, Lin Y H, Hou Z, Jiang Y G
Department of Urology, Affiliated Beijing Anzhen hospital of Capital Medical University, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2017 Jul 11;97(26):2028-2032. doi: 10.3760/cma.j.issn.0376-2491.2017.26.003.
To investigate the oncologic outcome and PSA kinetics of localized high-risk prostate cancer (PCa) patients treated with combination strategy of radiation therapy (RT) and maximal androgen blockade (MAB). We retrospectively reviewed the clinical data of 320 localized PCa patients undergoing RT+ MAB from 2001 to 2015. And radiation treatment protocol consisted of permanent prostate brachytherapy (PPB) at 110 Gy and EBRT at 45 Gy/23 fractions. The median follow-up time was 90 (range: 12-186) months. And 117 (36.6%) cases underwent MAB + external-beam radiotherapy (EBRT), and other 203 (63.4%) cases received MAB+ EBRT+ PPB. Multivariate Cox regression analyses showed that PSA kinetics were positive indicators of oncologic outcomes. Furthermore, PSA kinetics were aberrantly improved by supplemental PPB to MAB+ EBRT as following, PSA nadir (1.3±0.7)μg/L vs(0.11±0.06)μg/L, time of PSA decrease to nadir (7.5±1.8)months vs (3.2±2.1)months, PSA doubling time (15.6±4.2)months vs (22.6±6.1)months, PSA decreasing amplitude (84.6±6.2)%vs(95.8±3.4)%. Additionally, the median time of several important oncologic events in MAB+ EBRT+ PPB group were also prolonged than that in MAB+ EBRT group as following, overall survival (12.3 years vs 9.1 years, <0.001), biochemical recurrence-free survival (9.8 years vs 6.5 years, <0.001), skeletal-related event (10.4years vs 8.2 years, <0.001), and cytotoxic chemotherapy (11.6 years vs 8.8 years, =0.007). MAB+ EBRT+ PPB is extremely effective combination strategy for localized high-risk PCa patients, and PPB plays the important synergistic role in improving PSA kinetics, which are independent predictor for oncologic outcomes.
为研究接受放射治疗（RT）与最大雄激素阻断（MAB）联合策略治疗的局限性高危前列腺癌（PCa）患者的肿瘤学结局及前列腺特异性抗原（PSA）动力学。我们回顾性分析了2001年至2015年期间320例接受RT+MAB治疗的局限性PCa患者的临床资料。放射治疗方案包括110Gy的永久性前列腺近距离放疗（PPB）和45Gy/23次分割的外照射放疗（EBRT）。中位随访时间为90（范围：12 - 186）个月。其中117例（36.6%）患者接受MAB + 外照射放疗（EBRT），另外203例（63.4%）患者接受MAB+EBRT+PPB。多因素Cox回归分析显示，PSA动力学是肿瘤学结局的阳性指标。此外，在MAB+EBRT基础上加用PPB后PSA动力学有异常改善，如下所示：PSA最低点（1.3±0.7）μg/L对比（0.11±0.06）μg/L，PSA降至最低点的时间（7.5±1.8）个月对比（3.2±2.1）个月，PSA倍增时间（15.6±4.2）个月对比（22.6±6.1）个月，PSA下降幅度（84.6±6.2）%对比（95.8±3.4）%。此外，MAB+EBRT+PPB组中几个重要肿瘤学事件的中位时间也比MAB+EBRT组长，如下所示：总生存期（12.3年对比9.1年，<0.001），无生化复发生存期（9.8年对比6.5年，<0.001），骨相关事件（10.4年对比8.2年，<0.001），以及细胞毒性化疗（11.6年对比8.8年，=0.007）。MAB+EBRT+PPB是局限性高危PCa患者极其有效的联合策略，PPB在改善PSA动力学方面起重要协同作用，而PSA动力学是肿瘤学结局的独立预测指标。
