Fossati Nicola, Karnes R Jeffrey, Colicchia Michele, Boorjian Stephen A, Bossi Alberto, Seisen Thomas, Di Muzio Nadia, Cozzarini Cesare, Noris Chiorda Barbara, Fiorino Claudio, Gandaglia Giorgio, Dell'Oglio Paolo, Shariat Shahrokh F, Goldner Gregor, Joniau Steven, Battaglia Antonino, Haustermans Karin, De Meerleer Gert, Fonteyne Valérie, Ost Piet, Van Poppel Hendrik, Wiegel Thomas, Montorsi Francesco, Briganti Alberto
Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Eur Urol. 2018 Mar;73(3):436-444. doi: 10.1016/j.eururo.2017.07.026. Epub 2017 Aug 2.
Salvage radiation therapy (SRT) is a recommended treatment option for biochemical recurrence after radical prostatectomy (RP). However, its effectiveness may be limited to specific categories of patients.
We aimed to identify the optimal candidates for early SRT after RP.
DESIGN, SETTING, AND PARTICIPANTS: The study included 925 node-negative patients treated with SRT after RP at seven institutions. Patients received SRT for either prostate-specific antigen (PSA) rising, or PSA persistence after RP that was defined as PSA level ≥0.1 ng/ml at 1 mo after surgery. All patients received local radiation to the prostate and seminal vesicle bed.
The primary outcome measured was distant metastasis after SRT. Regression tree analysis was used to develop a risk-stratification tool. Multivariable Cox regression analysis and nonparametric curve fitting methods were used to explore the relationship between PSA level at SRT and the probability of metastasis-free survival at 8 yr.
At a median follow-up of 8.0 yr, 130 patients developed distant metastasis. At multivariable analysis, pre-SRT PSA level was significantly associated with distant metastasis (hazard ratio: 1.06, p<0.0001). However, when patients were stratified into five risk groups using regression tree analysis (area under the curve: 85%), early SRT administration provided better metastasis-free survival in three groups only: (1) low risk: undetectable PSA after RP, Gleason score ≤7, and tumour stage ≥pT3b, (2) intermediate risk: undetectable PSA after RP with Gleason score ≥8, (3) high risk: PSA persistence after RP with Gleason score ≤7.
We developed an accurate risk stratification tool to facilitate the individualised recommendation for early SRT based on prostate cancer characteristics. Early SRT proved to be beneficial only in selected groups of patients who are more likely to be affected by clinically significant but not yet systemic recurrence at the time of salvage treatment administration.
In patients affected by prostate cancer recurrence after radical prostatectomy, the early administration of salvage radiation therapy is beneficial only for selected subgroups of patients. In this study, these groups of patients were identified.
挽救性放射治疗（SRT）是根治性前列腺切除术（RP）后生化复发的推荐治疗选择。然而，其有效性可能仅限于特定类别的患者。
我们旨在确定RP后早期SRT的最佳候选者。
设计、设置和参与者：该研究纳入了7家机构中925例RP后接受SRT治疗的淋巴结阴性患者。患者因前列腺特异性抗原（PSA）升高或RP后PSA持续存在（定义为术后1个月时PSA水平≥0.1 ng/ml）而接受SRT。所有患者均接受前列腺和精囊床的局部放疗。
测量的主要结果是SRT后的远处转移。采用回归树分析开发风险分层工具。使用多变量Cox回归分析和非参数曲线拟合方法探讨SRT时PSA水平与8年无转移生存率之间的关系。
中位随访8.0年时，130例患者发生远处转移。在多变量分析中，SRT前PSA水平与远处转移显著相关（风险比：1.06，p<0.0001）。然而，当使用回归树分析将患者分为五个风险组时（曲线下面积：85%），早期SRT仅在三组患者中提供了更好的无转移生存率：（1）低风险：RP后PSA不可检测，Gleason评分≤7，肿瘤分期≥pT3b；（2）中风险：RP后PSA不可检测且Gleason评分≥8；（3）高风险：RP后PSA持续存在且Gleason评分≤7。
我们开发了一种准确的风险分层工具，以促进基于前列腺癌特征对早期SRT的个体化推荐。早期SRT仅在选定的患者组中被证明是有益的，这些患者在进行挽救性治疗时更有可能受到具有临床意义但尚未发生全身复发的影响。
在根治性前列腺切除术后发生前列腺癌复发的患者中，早期给予挽救性放射治疗仅对选定的亚组患者有益。在本研究中，确定了这些患者组。
