Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Jiangxi Institute of Urology, Nanchang, China.
Cancer Med. 2022 Sep;11(17):3251-3259. doi: 10.1002/cam4.4685. Epub 2022 Mar 21.
Prognostic indicators based on the initial prostate-specific antigen (PSA) levels, nadir PSA, and time to PSA nadir were calculated to evaluate prognosis after primary androgen deprivation therapy (PADT), as these have been reported in very few studies. We attempted to evaluate the prognostic role of the slope associated with nadir PSA in patients treated with PADT.
A total of 107 patients who were treated with PADT from 2015 to 2019 were reviewed. The Kaplan-Meier method and Cox regression model were used to analyze the prognostic significance of the slope associated with nadir PSA in predicting progression-free survival (PFS) and overall survival (OS).
After PADT, the median follow-up duration was 40.1 months; 66 patients (61.7%) had disease progression, and 33 patients (30.8%) died. In the univariate analysis, T stage, N stage, nadir PSA, time to PSA nadir, nadir PSA declining slope (nPSA-DS), nadir PSA percentage declining slope (nPSA-PDS), and nadir PSA line slope (nPSA-LS) were significant predictors for PFS and OS. The multivariate analysis showed that a higher nPSA-DS (> - 0.74) and lower PSA nadir (≤0.16 ng/ml) were independent predictors for prolonged survival. The significance of nPSA-DS and nPSA was supported by the analysis of nPSA-DS and nPSA as time-dependent covariates. The combined analyses demonstrated that patients with a higher nPSA-DS and lower PSA nadir had the best PFS and OS.
The slope associated with the nadir PSA of nPSA-DS was a significant independent predictor for patients treated with PADT. Nadir PSA and nPSA-DS have a synergistic effect on prognosis.
基于初始前列腺特异性抗原（PSA）水平、PSA 最低值和 PSA 达到最低值的时间，已经计算出了一些预后指标，用于评估原发雄激素剥夺治疗（PADT）后的预后，因为这些指标在极少数研究中被报道过。我们试图评估 PSA 最低值下降斜率在接受 PADT 治疗的患者中的预后作用。
回顾性分析了 2015 年至 2019 年期间接受 PADT 治疗的 107 例患者。采用 Kaplan-Meier 法和 Cox 回归模型分析了与 PSA 最低值下降斜率相关的斜率对预测无进展生存期（PFS）和总生存期（OS）的预后意义。
在 PADT 后，中位随访时间为 40.1 个月；66 例（61.7%）患者发生疾病进展，33 例（30.8%）患者死亡。单因素分析显示，T 分期、N 分期、PSA 最低值、PSA 达到最低值的时间、PSA 最低值下降斜率（nPSA-DS）、PSA 最低值下降百分比斜率（nPSA-PDS）和 PSA 最低值线斜率（nPSA-LS）是 PFS 和 OS 的显著预测因素。多因素分析显示，较高的 nPSA-DS（＞-0.74）和较低的 PSA 最低值（≤0.16ng/ml）是生存时间延长的独立预测因素。nPSA-DS 和 nPSA 作为时间依赖性协变量的分析支持了 nPSA-DS 和 nPSA 的意义。联合分析表明，nPSA-DS 较高且 PSA 最低值较低的患者具有最佳的 PFS 和 OS。
nPSA-DS 与 PSA 最低值相关的斜率是接受 PADT 治疗的患者的一个重要独立预测因素。PSA 最低值和 nPSA-DS 对预后有协同作用。
