Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea.
Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea.
PLoS One. 2021 Mar 12;16(3):e0248461. doi: 10.1371/journal.pone.0248461. eCollection 2021.
To determine the prognostic significance of long-term adjuvant androgen deprivation therapy (A-ADT) over 1 year in achieving undetectable levels of prostate-specific antigen (PSA) less than 0.001 ng/mL in prostate cancer patients with high- or very high-risk prostate cancer who underwent radiotherapy (RT).
A total of 197 patients with prostate cancer received RT, with a follow-up of ≥12 months. Biochemical failure was defined as PSA ≥nadir + 2 ng/mL after RT. We analyzed clinical outcomes, including survival, failure patterns, and prognostic factors affecting outcomes.
Biochemical failure-free survival (BCFFS), clinical failure-free survival, distant metastasis-free survival, cancer-specific survival, and overall survival (OS) rates at 5 years were 91.1%, 95.4%, 96.9%, 99.5%, and 89.1%, respectively. Administration of long-term A-ADT significantly predicted favorable BCFFS (p = 0.027) and OS (p < 0.001) in multivariate analysis. Nadir PSA ≤0.001 ng/mL was an independent prognostic factor for BCFFS (p = 0.006) and OS (p = 0.021). The use of long-term A-ADT significantly affected nadir PSA ≤0.001 ng/mL (p < 0.001). The patients with A-ADT for 1 year or longer had better BCFFS or OS than those for less than 1 year or those without A-ADT (p < 0.001). The best prognosis was demonstrated in patients treated with long-term A-ADT and nadir PSA ≤0.001 ng/mL in BCFFS (p < 0.001).
The addition of long-term A-ADT over 1 year to RT demonstrated good treatment outcomes in patients with locally advanced prostate cancer. Achieving a nadir PSA value ≤0.001 ng/mL using combination therapy with RT and A-ADT is a powerful clinical predictor of treatment outcomes.
本研究旨在探讨在接受放疗（RT）的高风险或极高风险前列腺癌患者中，长期（1 年以上）辅助雄激素剥夺治疗（A-ADT）使前列腺特异性抗原（PSA）水平降至低于 0.001ng/mL 的预后意义。
共有 197 例前列腺癌患者接受了 RT 治疗，随访时间≥12 个月。生化失败定义为 RT 后 PSA≥最低点+2ng/mL。我们分析了临床结果，包括生存、失败模式和影响结果的预后因素。
5 年时生化无失败生存率（BCFFS）、临床无失败生存率、远处转移无失败生存率、癌症特异性生存率和总生存率（OS）分别为 91.1%、95.4%、96.9%、99.5%和 89.1%。多因素分析显示，长期 A-ADT 治疗显著预测了有利的 BCFFS（p=0.027）和 OS（p<0.001）。最低点 PSA≤0.001ng/mL 是 BCFFS（p=0.006）和 OS（p=0.021）的独立预后因素。长期 A-ADT 的使用显著影响最低点 PSA≤0.001ng/mL（p<0.001）。接受 1 年或更长时间 A-ADT 治疗的患者的 BCFFS 或 OS 优于接受不到 1 年或未接受 A-ADT 治疗的患者（p<0.001）。在 BCFFS 中，长期 A-ADT 联合最低点 PSA≤0.001ng/mL 治疗的患者具有最佳预后（p<0.001）。
在局部晚期前列腺癌患者中，RT 联合 1 年以上的长期 A-ADT 治疗可获得良好的治疗效果。RT 和 A-ADT 联合治疗使最低点 PSA 值降至≤0.001ng/mL 是治疗结果的有力临床预测指标。
