Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
BJU Int. 2018 May;121(5):781-790. doi: 10.1111/bju.14122. Epub 2018 Jan 30.
To examine biochemical control, survival, and late morbidity with definitive low-dose-rate brachytherapy (LDR-BT) for patients with prostate cancer surviving for >10 years after treatment.
We identified 757 men with localised prostate cancer who underwent definitive LDR-BT in the period 1990-2006 and were followed for >10 years at our institution. Biochemical failure-free survival (BFFS), distant metastases-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were selected as study endpoints. Survival was examined using the log-rank test, Kaplan-Meier method, and Cox regression modelling. Urinary, quality of life (QoL), and potency scores at baseline and last follow-up were recorded.
The median follow-up was 12.5 years (range, 10.1-21.8 years). At the time of analysis, 88.6% of patients were alive, 1.5% died from prostate cancer and 13.9% developed biochemical failure, with 82% of failures occurring in the first decade of follow-up. Overall, 2.3% developed distant metastases. On multivariate analyses, stage T3a-T3b, prostate-specific antigen level of >20 ng/mL, intermediate- and high-risk disease predicted worse BFFS; whereas age >70 years at diagnosis and stage T3a-T3b predicted worse OS. A total biologically effective dose of ≥150 Gy and androgen-deprivation therapy were associated with improved BFFS, but not OS. The overall 17-year rates for BFFS, DMFS, PCSS, and OS were 79, 97, 97, and 72%, respectively. Respective 17-year BFFS rates for low-, intermediate- and high-risk patients were 86, 80, and 65% (P < 0.001), whereas OS rates for the same groups were 82, 73, and 60%, respectively (P = 0.09). Amongst those patients who were potent at baseline, 25% remained potent at the last follow-up. Urinary function and QoL were mainly unaffected.
LDR-BT yields excellent survival rates, with a 17-year PCSS rate of 97%. In all, 18% of patients with biochemical relapse failed at >10 years after implantation, which justifies their continued follow-up.
探讨接受低剂量率近距离放射治疗（LDR-BT）的前列腺癌患者在治疗后 10 年以上的生化控制、生存和晚期发病率。
我们确定了 757 名局部前列腺癌患者，他们在 1990-2006 年期间接受了根治性 LDR-BT，并在我们的机构进行了 >10 年的随访。生化无失败生存（BFFS）、远处转移无失败生存（DMFS）、前列腺癌特异性生存（PCSS）和总体生存（OS）被选为研究终点。使用对数秩检验、Kaplan-Meier 方法和 Cox 回归模型检查生存情况。记录基线和最后随访时的尿、生活质量（QoL）和勃起功能评分。
中位随访时间为 12.5 年（范围为 10.1-21.8 年）。在分析时，88.6%的患者存活，1.5%死于前列腺癌，13.9%发生生化失败，80%的失败发生在随访的第一个十年内。总体而言，2.3%发生远处转移。多因素分析显示，T3a-T3b 期、前列腺特异性抗原水平>20ng/ml、中高危疾病预测 BFFS 更差；而诊断时年龄>70 岁和 T3a-T3b 期预测 OS 更差。总生物有效剂量≥150Gy 和雄激素剥夺治疗与改善 BFFS 相关，但与 OS 无关。BFFS、DMFS、PCSS 和 OS 的总体 17 年累积发生率分别为 79%、97%、97%和 72%。低、中、高危患者的相应 17 年 BFFS 率分别为 86%、80%和 65%（P<0.001），而同一组患者的 OS 率分别为 82%、73%和 60%（P=0.09）。在基线时勃起功能正常的患者中，25%在最后一次随访时仍保持勃起功能正常。尿功能和 QoL 主要不受影响。
LDR-BT 可获得优异的生存率，17 年 PCSS 率为 97%。总的来说，18%的生化复发患者在植入后 >10 年失败，这证明了他们需要持续随访。
