治疗后游离前列腺特异性抗原比值能否用于预测复发性前列腺癌的不良结局？

Can post-treatment free PSA ratio be used to predict adverse outcomes in recurrent prostate cancer?

机构信息

Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada.

Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA.

出版信息

BJU Int. 2021 Jun;127(6):654-664. doi: 10.1111/bju.15236. Epub 2020 Sep 26.

DOI:10.1111/bju.15236

PMID:32926761

Abstract

OBJECTIVES

To assess whether free PSA ratio (FPSAR) at biochemical recurrence (BCR) can predict metastasis, castrate-resistant prostate cancer (CRPC), and cancer-specific survival (CSS), following therapy for localised disease.

PATIENTS AND METHODS

A single-centre retrospective cohort study (NCT03927287) including a discovery cohort composed of patients with an FPSAR after radical prostatectomy (RP) or radiotherapy (RT) between 2000 and 2017. For validation, an independent Biobank cohort of patients with BCR after RP was tested. Using a defined FPSAR cut-off, the metastasis-free-survival (MFS), CRPC-free survival, and CSS were compared. Multivariable Cox models determined the association between post-treatment FPSAR, metastases, and CRPC.

RESULTS

Overall, 822 patients (305 RP- and 363 RT-treated patients and 154 Biobank patients) were analysed. In the RP cohort, a total of 272/305 (89.1%) and 33/305 (10.9%) had a FPSAR test incidentally and reflexively, respectively. In the RT cohort, 155/363 (42.7%) and 208/263 (57.3%) had a FPSAR test incidentally and reflexively, respectively. However, in the prospective Biobank RP cohort, FPSAR testing was done on all samples of patients diagnosed with BCR. A FPSAR cut-off of 0.10 was determined using receiver operating characteristic analyses in both the RP and RT cohorts. A FPSAR of <0.10 resulted in longer median MFS (14.8 vs 9.3 years and 14.8 vs 13 years, respectively), and longer median CRPC-free survival (median not reached vs 9.9 years and 20.7 vs 13.8 years, respectively). Multivariable analyses showed that a FPSAR of ≥0.10 was associated with increased metastasis in the RP cohort (hazard ratio [HR] 1.915, 95% confidence interval [CI] 1.241-2.955) and RT cohort (HR 1.754, 95% CI 1.112-2.769), and increased CRPC in the RP cohort (HR 2.470, 95% CI 1.493-4.088). Findings were validated in the Biobank cohort.

CONCLUSIONS

A post-treatment FPSAR of ≥0.10 is associated with more aggressive disease, suggesting a potentially novel role for this biomarker.

摘要

目的

评估局部治疗后生化复发（BCR）时游离前列腺特异性抗原比值（FPSAR）是否可预测转移、去势抵抗性前列腺癌（CRPC）和癌症特异性生存（CSS）。

患者和方法

这是一项单中心回顾性队列研究（NCT03927287），包括一个发现队列，该队列由 2000 年至 2017 年期间接受根治性前列腺切除术（RP）或放疗（RT）后 FPSAR 异常的患者组成。为了验证，对接受 RP 后 BCR 的患者的独立生物库队列进行了测试。使用定义的 FPSAR 临界值，比较无转移生存（MFS）、CRPC 无生存和 CSS。多变量 Cox 模型确定了治疗后 FPSAR、转移和 CRPC 之间的关联。

结果

共分析了 822 例患者（RP 治疗 305 例，RT 治疗 363 例，生物库治疗 154 例）。在 RP 队列中，分别有 272/305（89.1%）和 33/305（10.9%）例患者因偶然和反射性原因进行了 FPSAR 检测。在 RT 队列中，分别有 155/363（42.7%）和 208/263（57.3%）例患者因偶然和反射性原因进行了 FPSAR 检测。然而，在前瞻性生物库 RP 队列中，对所有诊断为 BCR 的患者样本均进行了 FPSAR 检测。在 RP 和 RT 队列中，使用受试者工作特征分析确定了 FPSAR 截断值为 0.10。FPSAR<0.10 导致中位 MFS 更长（分别为 14.8 年 vs 9.3 年和 14.8 年 vs 13 年），中位 CRPC 无生存时间更长（中位未达到 vs 9.9 年和 20.7 年 vs 13.8 年）。多变量分析显示，在 RP 队列（风险比 [HR] 1.915，95%置信区间 [CI] 1.241-2.955）和 RT 队列（HR 1.754，95%CI 1.112-2.769）中，FPSAR≥0.10 与转移增加相关，在 RP 队列（HR 2.470，95%CI 1.493-4.088）中与 CRPC 增加相关。在生物库队列中验证了这些发现。