Pelger R C, Lycklama A Nijeholt G A, Zwinderman A H, Papapoulos S E, Hamdy N A
Department of Urology, University Hospital, Leiden, The Netherlands.
J Urol. 1996 Jul;156(1):122-6. doi: 10.1016/s0022-5347(01)65962-7.
We determined whether an early flare in serum alkaline phosphatase activity after orchiectomy was of prognostic value for progression-free survival in patients with advanced prostatic carcinoma.
A retrospective analysis of a data base from a Dutch multicenter study on prostatic carcinoma was done to determine the prognostic value of a flare in alkaline phosphatase activity after orchiectomy in 112 patients with metastatic (75%) or locally advanced (25%) disease. Cox's proportional hazards models and Kaplan-Meier survival curves were used.
Of the patients 50% had initially increased alkaline phosphatase levels and a flare in activity was demonstrated in 87% 2 to 4 weeks after orchiectomy. The prostate specific antigen nadir (cutoff 4 ng./ml.) 6 months after orchiectomy was of significant prognostic value for progression-free survival. A flare in alkaline phosphatase activity after orchiectomy demonstrated an early significant prognostic value for progression-free survival, independent of the serum alkaline phosphatase activity.
The simplicity, ready availability and cost-effectiveness of serum alkaline phosphatase activity as a prognostic index render it attractive to the clinician, particularly early in the course of prostatic carcinoma. Measuring the flare in alkaline phosphatase activity within 1 month of orchiectomy may permit early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from aggressive treatment.
我们确定睾丸切除术后血清碱性磷酸酶活性早期升高对于晚期前列腺癌患者无进展生存期是否具有预后价值。
对荷兰一项前列腺癌多中心研究的数据库进行回顾性分析，以确定睾丸切除术后碱性磷酸酶活性升高对112例转移性（75%）或局部晚期（25%）疾病患者的预后价值。使用Cox比例风险模型和Kaplan-Meier生存曲线。
50%的患者最初碱性磷酸酶水平升高，87%的患者在睾丸切除术后2至4周出现活性升高。睾丸切除术后6个月前列腺特异性抗原最低点（临界值4 ng/ml）对无进展生存期具有显著预后价值。睾丸切除术后碱性磷酸酶活性升高对无进展生存期具有早期显著预后价值，与血清碱性磷酸酶活性无关。
血清碱性磷酸酶活性作为一种预后指标，其简单性、易获得性和成本效益对临床医生具有吸引力，尤其是在前列腺癌病程早期。在睾丸切除术后1个月内测量碱性磷酸酶活性的升高，可能有助于早期识别疾病可能迅速进展且可能从积极治疗中获益的患者。
