a Department of Radiation Oncology , University Hospital Ulm , Germany.
b Department of Radiation Oncology , Esslingen Hospital , Germany.
Acta Oncol. 2018 Mar;57(3):362-367. doi: 10.1080/0284186X.2017.1364869. Epub 2017 Aug 17.
For patients with recurrent prostate cancer after radical prostatectomy (RP), salvage radiotherapy (SRT) is a second chance of cure. However, depending on risk factors, 40-70% of the patients experience further progression. With a focus on the pre- and post-SRT serum level of the prostate-specific antigen (PSA), we assessed the determinants of the long-term outcome after SRT.
Between 1997 and 2011, 464 patients received 3D-conformal SRT with median 66.6 Gy. The median PSA level before SRT was 0.31 ng/ml. In our retrospective analysis, post-SRT progression was defined as either a rising PSA >0.2 ng/ml above the nadir, or the application of anti-androgens or clinical recurrence. A PSA <0.1 ng/ml was termed undetectable. We analyzed the data with the Kaplan-Meier method (Logrank test) and multivariable Cox regression.
The median follow-up was 5.9 years. Overall, 178 patients had recurrence, 13 developed distant metastases and 30 died. Univariate, a pre-RP PSA <10 ng/ml, pathological stage pT <3, Gleason score <8, positive surgical margins, a pre-SRT PSA <0.2 ng/ml and a post-SRT PSA nadir <0.1 ng/ml correlated with fewer and later second recurrences. In a multivariable Cox model, pT, Gleason score, margin status and pre-SRT PSA were significant covariates of progression. If the post-SRT PSA response was included in the regression analysis, then a nadir ≥0.1 ng/ml was the strongest risk factor. Initiating SRT at a PSA <0.2 ng/ml correlated with a post-SRT PSA <0.1 ng/ml. Men who achieved an undetectable post-SRT PSA nadir also had lower rates of metastases and a better overall survival. However, there were too few events for Cox regression analysis of these two endpoints.
Early SRT at a PSA <0.2 ng/ml correlates with re-achieving an undetectable PSA, which predicts improved freedom from progression and metastases and better overall survival.
对于根治性前列腺切除术（RP）后复发的前列腺癌患者，挽救性放疗（SRT）是治愈的第二次机会。然而，根据风险因素，40-70%的患者会出现进一步进展。我们关注 SRT 前后前列腺特异性抗原（PSA）的血清水平，评估了 SRT 后长期结果的决定因素。
1997 年至 2011 年间，464 例患者接受了中位剂量为 66.6Gy 的 3D 适形 SRT。SRT 前 PSA 中位数为 0.31ng/ml。在我们的回顾性分析中，SRT 后进展定义为 PSA 升高>0.2ng/ml 以上且高于最低点，或应用抗雄激素或临床复发。PSA<0.1ng/ml 称为不可检测。我们使用 Kaplan-Meier 方法（Logrank 检验）和多变量 Cox 回归分析数据。
中位随访时间为 5.9 年。总的来说，178 例患者复发，13 例出现远处转移，30 例死亡。单因素分析显示，RP 前 PSA<10ng/ml、病理分期 pT<3、Gleason 评分<8、切缘阳性、SRT 前 PSA<0.2ng/ml 和 SRT 后 PSA 最低点<0.1ng/ml 与复发次数减少和复发时间延迟相关。在多变量 Cox 模型中，pT、Gleason 评分、切缘状态和 SRT 前 PSA 是进展的显著协变量。如果将 SRT 后 PSA 反应纳入回归分析，则最低点≥0.1ng/ml 是最强的危险因素。SRT 开始时 PSA<0.2ng/ml 与 SRT 后 PSA<0.1ng/ml 相关。达到 SRT 后 PSA 最低点不可检测的患者转移率也较低，总生存率较好。然而，这两个终点的 Cox 回归分析事件太少。
SRT 早期在 PSA<0.2ng/ml 时与再次达到 PSA 不可检测相关，这预测了无进展和转移的改善以及更好的总生存率。
