挽救性放疗治疗复发性前列腺癌：预后分级分组系统能否为治疗时机提供信息？
Salvage Radiotherapy for Recurrent Prostate Cancer: Can the Prognostic Grade Group System Inform Treatment Timing?
机构信息
Department of Urology, Singapore General Hospital, SingHealth Duke-NUS Academic Medical Center, Singapore.
Duke University Medical Center, Durham, NC.
出版信息
Clin Genitourin Cancer. 2019 Oct;17(5):e930-e938. doi: 10.1016/j.clgc.2019.05.007. Epub 2019 May 24.
PURPOSE
In order to better time salvage radiotherapy (SRT) for post-radical prostatectomy biochemical failure, we examined the association between pre-SRT prostate-specific antigen (PSA) and PSA control as a function of the new prognostic grade group (PGG) system.
PATIENTS AND METHODS
Using the Shared Equal Access Regional Cancer Hospital database, we identified men after radical prostatectomy with PSA > 0.2 ng/mL and without cancer involvement of lymph nodes who underwent SRT alone. SRT failure was defined as post-SRT PSA nadir + 0.2 ng/mL or receipt of post-SRT hormone therapy. Men were stratified by pre-SRT PSA (0.2-0.49, 0.5-0.99, and ≥ 1.0 ng/mL). Multivariable Cox models were used to test the association between pre-SRT PSA and SRT failure, stratified by PGG.
RESULTS
A total of 358 men met the inclusion criteria and comprised our study cohort. Median post-SRT follow-up was 78 months. A total of 174 men (49%) had pre-SRT PSA 0.2-0.49 ng/mL, 97 (27%) PSA 0.5-0.99 ng/mL, and 87 (24%) PSA ≥ 1.0 ng/mL. On multivariable analysis among men with PGG 1-2, pre-SRT PSA 0.2-0.49 ng/mL had similar outcomes as PSA 0.5-0.99 ng/mL; those with PSA ≥ 1.0 ng/mL had higher recurrence risks (hazard ratio = 2.78, P < .001). Among PGG 3-5, PSA 0.5-0.99 ng/mL or ≥ 1.0 ng/mL had a higher recurrence risk (hazard ratio = 2.15, P = .021; and hazard ratio = 2.49, P = .010, respectively) versus PSA 0.2-0.49 ng/mL.
CONCLUSION
In men with higher-grade prostate cancer (PGG 3-5), SRT should be provided earlier (PSA < 0.5 ng/mL), while among men with lower-grade disease (PGG 1-2), SRT results in equal PSA control up to PSA 1.0 ng/mL.
目的
为了更好地把握挽救性放疗（SRT）治疗根治性前列腺切除术后生化失败的时机，我们研究了新的预后分级组（PGG）系统中治疗前前列腺特异抗原（PSA）与 PSA 控制之间的关系。
方法
我们利用共享平等获取区域癌症医院数据库，确定了根治性前列腺切除术后 PSA ＞0.2ng/mL 且无淋巴结转移的患者，这些患者单独接受了 SRT。将 SRT 失败定义为 SRT 后 PSA 最低值+0.2ng/mL 或接受 SRT 后激素治疗。根据治疗前 PSA（0.2-0.49ng/mL、0.5-0.99ng/mL 和≥1.0ng/mL）将患者分层。使用多变量 Cox 模型，根据 PGG 对治疗前 PSA 与 SRT 失败之间的关系进行分层检验。
结果
共有 358 名符合纳入标准的男性患者组成了本研究队列。中位 SRT 随访时间为 78 个月。174 名（49%）患者的治疗前 PSA 为 0.2-0.49ng/mL，97 名（27%）PSA 为 0.5-0.99ng/mL，87 名（24%）PSA≥1.0ng/mL。在 PGG 为 1-2 的男性中，多变量分析显示治疗前 PSA 0.2-0.49ng/mL 的结果与 PSA 0.5-0.99ng/mL 相似；PSA≥1.0ng/mL 的患者复发风险更高（危险比=2.78，P＜0.001）。在 PGG 为 3-5 的患者中，PSA 0.5-0.99ng/mL 或 PSA≥1.0ng/mL 的患者复发风险更高（危险比=2.15，P=0.021；危险比=2.49，P=0.010），而 PSA 0.2-0.49ng/mL 的患者则较低。
结论
在高级别前列腺癌（PGG 3-5）患者中，应较早进行 SRT（PSA＜0.5ng/mL），而在低级别疾病（PGG 1-2）患者中，PSA 控制至 1.0ng/mL 时 SRT 结果相同。
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