Freeman J A, Lieskovsky G, Cook D W, Petrovich Z, Chen S, Groshen S, Skinner D G
Department of Urology, University of Southern California School of Medicine, Los Angeles.
J Urol. 1993 May;149(5):1029-34. doi: 10.1016/s0022-5347(17)36288-2.
Between 1976 and 1989, 114 patients undergoing radical retropubic prostatectomy and bilateral pelvic lymph node dissection for prostatic adenocarcinoma were found to have stage PcN0 lesions. Postoperative adjuvant radiation therapy without hormonal treatment was given to 95 of these patients (83%): 26 (27%) with stage C1, 37 (39%) with stage C2 and 32 (34%) with stage C3 disease. The median radiation dose was 45 Gy. given at 180 cGy. daily. Median followup was 4.4 years (range 1.4 to 13.3). The overall 5 and 10-year actuarial rates for the patients were 94% and 70%, respectively. Disease-specific 5 and 10-year actuarial survival rates were 99% and 78%, respectively. At 5 and 10 years the chance of clinical recurrence was estimated as 6% and 13%, respectively, and the chance of recurrence (clinical or indicated by prostate specific antigen levels) was estimated to be 34% and 46%, respectively. Patients with high Gleason scores (8 to 10) and seminal vesicle involvement (stage C3) fared worst. There were 5 patients with clinical distant metastases, 1 with a clinical local recurrence and 1 with both conditions. Detectable elevation of prostate specific antigen without clinically evident recurrence was noted in 25 patients. Radiation therapy was well tolerated with minimal morbidity. Disease-specific survival and survival without clinical recurrence were improved over historical control in patients with stage PcN0 prostate cancer treated by radical prostatectomy alone. These data support a role for adjuvant radiation therapy in stage PcN0 prostate adenocarcinoma following radical prostatectomy.
1976年至1989年间，114例因前列腺腺癌接受耻骨后根治性前列腺切除术及双侧盆腔淋巴结清扫术的患者被发现患有PcN0期病变。其中95例患者（83%）接受了术后辅助放疗且未进行激素治疗：C1期26例（27%），C2期37例（39%），C3期32例（34%）。中位放疗剂量为45 Gy，每日180 cGy。中位随访时间为4.4年（范围1.4至13.3年）。患者的总体5年和10年精算生存率分别为94%和70%。疾病特异性5年和10年精算生存率分别为99%和78%。5年和10年时临床复发的几率分别估计为6%和13%，复发（临床或前列腺特异性抗原水平提示）的几率分别估计为34%和46%。Gleason评分高（8至10分）且有精囊受累（C3期）的患者预后最差。有5例发生临床远处转移，1例发生临床局部复发，1例两者皆有。25例患者出现前列腺特异性抗原可检测性升高但无临床明显复发。放疗耐受性良好，并发症极少。与仅接受根治性前列腺切除术治疗的PcN0期前列腺癌患者的历史对照相比，疾病特异性生存率和无临床复发生存率有所提高。这些数据支持辅助放疗在根治性前列腺切除术后PcN0期前列腺腺癌中的作用。
