根治性前列腺切除术后生化复发时间及挽救性放疗对前列腺癌患者的疗效。
Time to biochemical relapse after radical prostatectomy and efficacy of salvage radiotherapy in patients with prostate cancer.
机构信息
Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, South Korea.
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
出版信息
Int J Clin Oncol. 2019 Oct;24(10):1238-1246. doi: 10.1007/s10147-019-01463-5. Epub 2019 May 13.
BACKGROUND
To investigate the prognostic and therapeutic implications of time to biochemical relapse (BCR) in patients with prostate cancer after radical prostatectomy.
METHODS
The records of 3210 consecutive men with prostate cancer who underwent radical prostatectomy between January 1998 and June 2013 were retrospectively reviewed. Patients with BCR were divided into three groups based on quartiles of time to BCR, namely an early group (first quartile), an intermediate group (second and third quartiles) and late group (fourth quartile).
RESULTS
817 (25.5%) patients experienced BCR at a median of 24.9 months after surgery. The 8-year rate of distant metastasis-free survival (64.3% vs. 41.3%, p = 0.002) and cancer-specific survival (86.6% vs. 63.4%, p < 0.001) was higher in the salvage radiotherapy (SRT) group than the androgen deprivation therapy (ADT) group in patients with early BCR, whereas those rates (91.3% vs. 87.9%, p = 0.607 and 100.0% vs. 93.1%, p = 0.144, respectively) were similar in patients with late BCR. In the intermediate BCR group, the impact of SRT over ADT on 8-year cancer-specific survival was modest (91.9% vs. 82.3%, p = 0.057) and was limited to patients with pT2 or pT3a disease.
CONCLUSIONS
SRT may decrease the risk of distant metastasis and cancer-specific mortality in patients with early BCR. However, a survival benefit for those with late BCR was not apparent. For patients with intermediate BCR, SRT was associated with a cancer-specific survival benefit in patients with pT2 or pT3a disease. Novel genomic tests and imaging modalities may support clinical decision-making in these patients.
背景
研究前列腺癌根治术后生化复发（BCR）时间对患者预后和治疗的影响。
方法
回顾性分析 1998 年 1 月至 2013 年 6 月间接受根治性前列腺切除术的 3210 例连续前列腺癌患者的病历资料。根据 BCR 时间的四分位距将患者分为三组，即早期组（第 1 四分位距）、中期组（第 2 四分位距和第 3 四分位距）和晚期组（第 4 四分位距）。
结果
817（25.5%）例患者在术后中位时间 24.9 个月时发生 BCR。早期 BCR 患者中，挽救性放疗（SRT）组的远处无转移生存（64.3%比 41.3%，p=0.002）和癌症特异性生存（86.6%比 63.4%，p<0.001）率高于雄激素剥夺治疗（ADT）组，而晚期 BCR 患者中两组间这些比率（91.3%比 87.9%，p=0.607 和 100.0%比 93.1%，p=0.144）相似。在中期 BCR 组中，SRT 对 ADT 对 8 年癌症特异性生存的影响适度（91.9%比 82.3%，p=0.057），仅限于 pT2 或 pT3a 疾病患者。
结论
SRT 可能降低早期 BCR 患者远处转移和癌症特异性死亡率的风险。然而，晚期 BCR 患者的生存获益并不明显。对于中期 BCR 患者，SRT 与 pT2 或 pT3a 疾病患者的癌症特异性生存获益相关。新型基因组检测和影像学方法可能为这些患者的临床决策提供支持。
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