根治性前列腺切除术后 PSA 持续升高的高危前列腺癌患者早期挽救性治疗对肿瘤学结局的获益。
Benefits of early salvage therapy on oncological outcomes in high-risk prostate cancer with persistent PSA after radical prostatectomy.
机构信息
Medical Academy, Department of Urology, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307, Kaunas, Lithuania.
Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
出版信息
Clin Transl Oncol. 2022 Feb;24(2):371-378. doi: 10.1007/s12094-021-02700-y. Epub 2021 Aug 28.
BACKGROUND
Patients with prostate-specific antigen (PSA) persistence are at the increased risk of disease progression. The aim of our study was to evaluate the impact of early salvage therapy on oncological outcomes in patients with persistent PSA after radical prostatectomy (RP).
METHODS
Within a single tertiary centre database, we identified men with persistent (≥ 0.1 ng/ml) versus undetectable (< 0.1 ng/ml) PSA 4-8 weeks after RP for high-risk prostate cancer (HRPCa). The cumulative incidence function was used to estimate cancer-specific survival (CSS) and clinical progression-free survival (CPFS). The Kaplan-Meier method was used to estimate overall survival (OS). The effects on oncological outcomes of salvage radiotherapy (SRT) ± androgen deprivation therapy (ADT) vs. ADT monotherapy were tested in the subgroup of patients with persistent PSA.
RESULTS
Of 414 consecutive patients who underwent RP for HRPC, 125 (30.2%) had persistent PSA. Estimated 10-year CPFS, CSS and OS for men with persistent vs. undetectable PSA were 63.8% vs. 93.5%, 78.5% vs. 98.3% and 54% vs. 83.2% (all p < 0.0001), respectively. In men with persistent PSA, ADT alone was associated with higher risk (hazard ratio (HR) for worse CSS (HR 3.9, p = 0.005) and OS (HR 4.7, p < 0.0001) but not for CP (HR 1.6, p = 0.2) when compared with SRT ± ADT.
CONCLUSION
In patients who underwent RP for HRPCa, persistent PSA was associated with poor oncological outcomes. Early SRT ± ADT resulted in significantly improved CSS and OS in men with persistent PSA comparing with early androgen deprivation monotherapy.
背景
前列腺特异性抗原（PSA）持续存在的患者疾病进展的风险增加。我们的研究旨在评估根治性前列腺切除术（RP）后 PSA 持续（≥0.1ng/ml）患者早期挽救性治疗对肿瘤学结果的影响。
方法
在单一的三级中心数据库中，我们确定了高危前列腺癌（HRPCa）患者中 RP 后 4-8 周 PSA 持续（≥0.1ng/ml）与不可检测（<0.1ng/ml）的患者。使用累积发生率函数估计癌症特异性生存（CSS）和临床无进展生存（CPFS）。Kaplan-Meier 法用于估计总生存（OS）。在 PSA 持续的患者亚组中，测试了挽救性放疗（SRT）±雄激素剥夺治疗（ADT）与 ADT 单药治疗对肿瘤学结果的影响。
结果
在 414 例接受 RP 治疗 HRPC 的连续患者中，125 例（30.2%）PSA 持续存在。PSA 持续与不可检测的患者的 10 年 CPFS、CSS 和 OS 估计值分别为 63.8%与 93.5%、78.5%与 98.3%和 54%与 83.2%（均 p<0.0001）。在 PSA 持续存在的患者中，ADT 单药治疗与 CSS（风险比（HR）为 3.9，p=0.005）和 OS（HR 为 4.7，p<0.0001）更差相关，但与 CP 无关（HR 为 1.6，p=0.2），与 SRT±ADT 相比。
结论
在接受 HRPCa 行 RP 的患者中，PSA 持续存在与肿瘤学结果不良相关。与早期雄激素剥夺单药治疗相比，早期 SRT±ADT 可显著改善 PSA 持续患者的 CSS 和 OS。
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