可检测到的放疗后前列腺特异性抗原终点有助于识别远处复发和癌症特异性死亡风险高的不良中危前列腺癌男性患者。

Detectable end of radiation prostate specific antigen assists in identifying men with unfavorable intermediate-risk prostate cancer at high risk of distant recurrence and cancer-specific mortality.

作者信息

Hayman Jonathan, Phillips Ryan, Chen Di, Perin Jamie, Narang Amol K, Trieu Janson, Radwan Noura, Greco Stephen, Deville Curtiland, McNutt Todd, Song Daniel Y, DeWeese Theodore L, Tran Phuoc T

机构信息

Department of Internal Medicine, Johns Hopkins Bayview Hospital, Baltimore, Maryland.

Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, Maryland.

出版信息

Prostate. 2018 Jun;78(8):623-630. doi: 10.1002/pros.23507. Epub 2018 Mar 9.

DOI:10.1002/pros.23507

PMID:29520847

Abstract

BACKGROUND

Undetectable End of Radiation PSA (EOR-PSA) has been shown to predict improved survival in prostate cancer (PCa). While validating the unfavorable intermediate-risk (UIR) and favorable intermediate-risk (FIR) stratifications among Johns Hopkins PCa patients treated with radiotherapy, we examined whether EOR-PSA could further risk stratify UIR men for survival.

METHODS

A total of 302 IR patients were identified in the Johns Hopkins PCa database (178 UIR, 124 FIR). Kaplan-Meier curves and multivariable analysis was performed via Cox regression for biochemical recurrence free survival (bRFS), distant metastasis free survival (DMFS), and overall survival (OS), while a competing risks model was used for PCa specific survival (PCSS). Among the 235 patients with known EOR-PSA values, we then stratified by EOR-PSA and performed the aforementioned analysis.

RESULTS

The median follow-up time was 11.5 years (138 months). UIR was predictive of worse DMFS and PCSS (P = 0.008 and P = 0.023) on multivariable analysis (MVA). Increased radiation dose was significant for improved DMFS (P = 0.016) on MVA. EOR-PSA was excluded from the models because it did not trend towards significance as a continuous or binary variable due to interaction with UIR, and we were unable to converge a multivariable model with a variable to control for this interaction. However, when stratifying by detectable versus undetectable EOR-PSA, UIR had worse DMFS and PCSS among detectable EOR-PSA patients, but not undetectable patients. UIR was significant on MVA among detectable EOR-PSA patients for DMFS (P = 0.021) and PCSS (P = 0.033), while RT dose also predicted PCSS (P = 0.013).

CONCLUSIONS

EOR-PSA can assist in predicting DMFS and PCSS among UIR patients, suggesting a clinically meaningful time point for considering intensification of treatment in clinical trials of intermediate-risk men.

摘要

背景

放射治疗后前列腺特异性抗原（PSA）不可检测的放疗结束时PSA（EOR-PSA）已被证明可预测前列腺癌（PCa）患者生存率的提高。在对接受放疗的约翰霍普金斯医院PCa患者中的不良中危（UIR）和良好中危（FIR）分层进行验证时，我们研究了EOR-PSA是否能进一步对UIR男性患者的生存风险进行分层。

方法

在约翰霍普金斯医院PCa数据库中识别出302例中危患者（178例UIR，124例FIR）。通过Cox回归对生化无复发生存期（bRFS）、无远处转移生存期（DMFS）和总生存期（OS）进行Kaplan-Meier曲线分析和多变量分析，同时使用竞争风险模型分析前列腺癌特异性生存期（PCSS）。在235例已知EOR-PSA值的患者中，我们随后根据EOR-PSA进行分层并进行上述分析。

结果

中位随访时间为11.5年（138个月）。多变量分析（MVA）显示，UIR预示着更差的DMFS和PCSS（P = 0.008和P = 0.023）。多变量分析显示，增加放疗剂量对改善DMFS具有显著意义（P = 0.016）。EOR-PSA被排除在模型之外，因为由于与UIR的相互作用，它作为连续变量或二元变量均未呈现出显著趋势，并且我们无法构建一个包含控制这种相互作用变量的多变量模型。然而，当按可检测与不可检测的EOR-PSA进行分层时，在可检测EOR-PSA的患者中，UIR的DMFS和PCSS更差，但在不可检测的患者中并非如此。在可检测EOR-PSA的患者中，多变量分析显示UIR对DMFS（P = 0.021）和PCSS（P = 0.033）具有显著意义，而放疗剂量也可预测PCSS（P = 0.013）。