前列腺切除术后的前列腺癌患者的挽救性放射治疗。

Salvage radiation therapy for prostate cancer patients after prostatectomy.

机构信息

Department of Urology, Tokyo Medical University, Tokyo, Japan.

Department of Radiology, Tokyo Medical University, Tokyo, Japan.

出版信息

Jpn J Clin Oncol. 2019 Mar 1;49(3):281-286. doi: 10.1093/jjco/hyy195.

DOI:10.1093/jjco/hyy195

PMID:30608594

Abstract

OBJECTIVES

The aim of this study was to identify risk factors to predict a biochemical recurrence (BCR) in patients treated with salvage radiation therapy (SRT) after radical prostatectomy (RP).

METHODS

We retrospectively reviewed 122 Japanese patients who received SRT for BCR after RP. Using uni- and multivariate Cox proportional hazard models, we identified the predictive factors of BCR after SRT.

RESULTS

With a median follow-up of 61.3 months, 45.9% of the patients showed BCR after SRT, with 61.5 and 41.8% of non-BCR rates at the second and fifth years. Univariate proportional hazards analysis demonstrated that extraprostatic disease (P = 0.029), seminal vesicle invasion (P = 0.005), microvascular invasion (P = 0.001), postoperative Gleason score (P = 0.008) and pre-SRT prostate-specific antigen (PSA) (P = 0.005) were significantly associated with BCR after SRT. However, only the presence of microvascular invasion and a higher pre-SRT PSA were significant predictors in the multivariate analysis. The non-BCR rate in the second year after SRT for 15 patients with microvascular invasion and pre-SRT PSA > 1.2 ng/ml was only 21% compared to 72.5% of 72 patients with negative microvascular invasion and a pre-SRT PSA of <1.2 ng/ml (P = 0.000031).

CONCLUSIONS

While SRT is the most important secondary treatment option for patients with BCR after RP, the effectiveness of SRT may not be uniform. The combination of risk factors such as microvascular invasion in RP specimens and pre-SRT PSA may provide a better way to stratify the risk of BCR after SRT.

摘要

目的

本研究旨在确定接受根治性前列腺切除术（RP）后挽救性放疗（SRT）治疗的患者发生生化复发（BCR）的风险因素。

方法

我们回顾性分析了 122 例接受 SRT 治疗 RP 后 BCR 的日本患者。使用单变量和多变量 Cox 比例风险模型，我们确定了 SRT 后 BCR 的预测因素。

结果

中位随访 61.3 个月后，45.9%的患者在 SRT 后出现 BCR，无 BCR 的比例分别为 61.5%和 41.8%，在第 2 年和第 5 年。单变量比例风险分析表明，前列腺外疾病（P=0.029）、精囊侵犯（P=0.005）、微血管侵犯（P=0.001）、术后 Gleason 评分（P=0.008）和 SRT 前前列腺特异性抗原（PSA）（P=0.005）与 SRT 后 BCR 显著相关。然而，多变量分析仅显示微血管侵犯的存在和较高的 SRT 前 PSA 是显著的预测因素。在 15 例有微血管侵犯和 SRT 前 PSA>1.2ng/ml 的患者中，SRT 后第 2 年无 BCR 的比例仅为 21%，而在 72 例无微血管侵犯和 SRT 前 PSA<1.2ng/ml 的患者中，无 BCR 的比例为 72.5%（P=0.000031）。