Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
BMC Cancer. 2017 Nov 23;17(1):789. doi: 10.1186/s12885-017-3775-6.
The magnitude and rapidity of the tumor response to androgen deprivation is known to predict the durability of the therapy. We have investigated the predictive value of categorizing patients by the half-life of PSA under neoadjuvant androgen deprivation therapy in patients with biochemical recurrence after radical prostatectomy.
Medical records of 317 patients who received neoadjuvant androgen deprivation therapy before radical prostatectomy and developed biochemical recurrence were analyzed. The patients were categorized into five groups according to PSA half-life. Risk of developing castration resistance was evaluated by Kaplan-Meier analysis and by Cox proportional risk regression analysis.
The median follow-up duration was 50.1 months (IQR 31.8-68.7) and median PSA half-life was 22.1 days (IQR 12.7-38.4). Comparison of survival curves revealed that patients in the intermediate response group showed significantly lower 5-year castration-resistant prostate cancer rate (37.5%) compared to non-response and ultra-rapid response groups (63.6%, p = 0.007; 56.1%, p = 0.031; respectively). In the multivariate regression model, intermediate response compared to non-response was associated with significantly reduced risk of castration resistance development (hazard ratio 0.397, 95% confidence interval 0.191-0.823, p = 0.013) and overall mortality (hazard ratio 0.138, 95% confidence interval 0.033-0.584, p = 0.007). When subcategorized by Gleason score, Kaplan-Meier curve revealed that, in the high Gleason score stratum, 5-year castration-resistant prostate cancer rate for intermediate response group (44.0%) was exceptionally lower than that in non-response group (66.7%, p = 0.047), while castration resistance increased in other groups.
Short PSA half-life as well as no response after androgen deprivation is associated with increased risk of treatment failure compared to intermediate PSA half-life.
雄激素剥夺治疗后肿瘤反应的幅度和速度已知可预测治疗的持久性。我们研究了通过新辅助雄激素剥夺治疗后前列腺癌根治术后生化复发患者的 PSA 半衰期对患者进行分类的预测价值。
分析了 317 例接受新辅助雄激素剥夺治疗后发生生化复发并接受前列腺癌根治术的患者的病历。根据 PSA 半衰期将患者分为五组。通过 Kaplan-Meier 分析和 Cox 比例风险回归分析评估发生去势抵抗的风险。
中位随访时间为 50.1 个月（IQR 31.8-68.7），PSA 半衰期中位数为 22.1 天（IQR 12.7-38.4）。生存曲线比较显示，中间反应组患者的 5 年去势抵抗前列腺癌发生率明显低于无反应组和超快速反应组（63.6%，p=0.007；56.1%，p=0.031）。在多变量回归模型中，与无反应相比，中间反应与去势抵抗发展风险降低显著相关（风险比 0.397，95%置信区间 0.191-0.823，p=0.013）和总死亡率（风险比 0.138，95%置信区间 0.033-0.584，p=0.007）。按照 Gleason 评分亚组分类，Kaplan-Meier 曲线显示在高 Gleason 评分组中，中间反应组的 5 年去势抵抗前列腺癌发生率（44.0%）明显低于无反应组（66.7%，p=0.047），而其他组的去势抵抗发生率增加。
与中间 PSA 半衰期相比，PSA 半衰期较短和雄激素剥夺后无反应与治疗失败风险增加相关。
