前列腺癌根治术后挽救性放射治疗：生存分析

Salvage radiation therapy after radical prostatectomy: survival analysis.

作者信息

Galla Andrea, Maggio Angelo, Delmastro Elena, Garibaldi Elisabetta, Gabriele Pietro, Bresciani Sara, Di Dia Amalia, Stasi Michele, Gabriele Domenico

机构信息

Division of Radiation Therapy, Candiolo Cancer Institute, Candiolo, Turin, Italy.

Division of Medical Physics, Candiolo Cancer Institute, Candiolo, Turin, Italy -

出版信息

Minerva Urol Nefrol. 2019 Jun;71(3):240-248. doi: 10.23736/S0393-2249.18.03124-7. Epub 2018 Jul 23.

DOI:10.23736/S0393-2249.18.03124-7

PMID:30037205

Abstract

BACKGROUND

To evaluate the outcome of patients treated with salvage radiotherapy after radical prostatectomy and to investigate the effects of independent predictors on survival.

METHODS

From January 2000 to December 2015, 234 patients with biochemical/clinical recurrences after radical prostatectomy were submitted to salvage radiotherapy (SRT). One hundred and fifty-seven patients (67%) received three-dimensional (3D) conformal radiotherapy while 77 patients (33%) were treated with intensity-modulated radiotherapy (IMRT) or IMRT/image-guided radiotherapy by tomotherapy. The median RT dose to prostate bed was 70.2 Gy (range: 66-79 Gy). The investigated endpoints were biochemical relapse-free survival (BRFS), clinical relapse-free survival (CRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific survival (PCSS). Different covariates were considered to investigate predictors of survival.

RESULTS

With a median follow-up of 117 months the BRFS, CRFS, DMFS and PCSS at 10 years were 54%, 84%, 90%, and 94%, respectively. In multivariate analysis (MVA), the pathological Gleason Score (pGS) was the most important factor affecting BRFS, CRFS, DMFS and PCSS (P<0.007, HR>1.55); pathological stage (pT) was predictor of BRFS (P=0.007, HR=1.7) and PCSS (P=0.02, HR=4.2), and the last prostate-specific antigen during follow-up was an important survival predictor of CRFS (P=0.004, HR=1.26) and PCSS (P<0.0001, HR=1.04). The time between surgery and the start of SRT was correlated with BRFS (P<0.0001, HR=0.987) and CRFS (P=0.047, HR=0.989). In univariate analysis (UVA), positive surgical margins at the prostatectomy specimen improved BRFS (P=0.01, HR=0.54), CRFS (P=0.05, HR=0.46) and DMFS (P=0.005, HR=0.13) after SRT.

CONCLUSIONS

At long-term follow-up, excellent outcome results of SRT on BRFS, CRFS, DMFS, and PCSS were obtained. Several prognostic factors such as pGS, pT and surgical margin status were found to be predictors of survival.

摘要

背景

评估根治性前列腺切除术后接受挽救性放疗患者的预后，并研究独立预测因素对生存的影响。

方法

2000年1月至2015年12月，234例根治性前列腺切除术后出现生化/临床复发的患者接受了挽救性放疗（SRT）。157例患者（67%）接受三维（3D）适形放疗，77例患者（33%）接受调强放疗（IMRT）或断层放疗引导的IMRT/图像引导放疗。前列腺床的中位放疗剂量为70.2 Gy（范围：66 - 79 Gy）。研究的终点指标为生化无复发生存期（BRFS）、临床无复发生存期（CRFS）、远处转移无复发生存期（DMFS）和前列腺癌特异性生存期（PCSS）。考虑不同的协变量以研究生存的预测因素。

结果

中位随访117个月时，10年的BRFS、CRFS、DMFS和PCSS分别为54%、84%、90%和94%。在多因素分析（MVA）中，病理Gleason评分（pGS）是影响BRFS、CRFS、DMFS和PCSS的最重要因素（P<0.007，HR>1.55）；病理分期（pT）是BRFS（P = 0.007，HR = 1.7）和PCSS（P = 0.02, HR = 4.2）的预测因素，随访期间的最后一次前列腺特异性抗原是CRFS（P = 0.004，HR = 1.26）和PCSS（P<0.0001，HR = 1.04）的重要生存预测因素。手术与SRT开始之间的时间与BRFS（P<0.0001，HR = 0.987）和CRFS（P = 0.047，HR = 0.989）相关。在单因素分析（UVA）中，前列腺切除标本的手术切缘阳性改善了SRT后的BRFS（P = 0.01，HR = 0.54）、CRFS（P = 0.05，HR = 0.46）和DMFS（P = 0.005，HR = 0.13）。