Anderson P R, Hanlon A L, Patchefsky A, Al-Saleem T, Hanks G E
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Int J Radiat Oncol Biol Phys. 1998 Jul 15;41(5):1087-92. doi: 10.1016/s0360-3016(98)00167-9.
It has been well established that prostate cancer patients with pretreatment PSA <10 ng/ml enjoy excellent bNED control when treated with definitive external beam radiation therapy. This report identifies predictors of failure for patients with pretreatment PSA <10 ng/ml. These predictors are then used to define favorable and unfavorable prognostic subgroups of patients for which bNED control is compared.
Between 3/87 and 11/94, 266 patients with T1-T3NXM0 prostate cancer and pretreatment PSA values <10 ng/ml were treated with definitive external beam radiation therapy. Median central axis dose and median follow-up for the entire group was 72 Gy (63-79 Gy) and 48 months (2-120 months). Predictors of bNED control were evaluated univariately using Kaplan-Meier methodology and the log-rank test and multivariately using Cox proportional hazards modeling. Covariates considered were pretreatment PSA, palpation stage, Gleason score, presence of perineual invasion (PNI) and central axis dose. Independent predictors based on multivariate results were then used to stratify the patients into two prognostic groups for which bNED control was compared. bNED failure is defined as PSA > or = 1.5 ng/ml and rising on two consecutive determinations.
Univariate analysis according to pretreatment and treatment factors for bNED control demonstrates a statistically significant improvement in 5-year bNED control for patients with Gleason score 2-6 vs. 7-10, patients without evidence of perineural invasion (PNI) vs. those with PNI, and patients with palpation stage T1/T2AB vs. T2C/T3. Multivariate analysis demonstrates that Gleason score (p = 0.0496), PNI (p = 0.0008) and palpation stage (p = 0.0153) are significant independent predictors of bNED control. Based on these factors, patients are stratified into a more favorable prognosis group (Gleason 2-6, no PNI, and stage T1/T2AB, n = 172) and a less favorable prognosis group (Gleason 7-10 or PNI or T2C/T3, n = 94). A comparison of the two groups reveals that bNED control is significantly lower in the less favorable prognosis group (74% vs. 91% at 5 years, p = 0.0024).
(1) This report identifies Gleason 7-10 and the presence of PNI as well as palpation stage T2C/T3 as factors that predict worse bNED outcome for patients with pretreatment PSA <10 ng/ml who are treated with radiation therapy alone. (2) Patients with these pretreatment prognostic factors may benefit from adjuvant therapies or altered treatment programs. (3) In order to make fair comparisons between radiation therapy and prostatectomy series, the distribution of perineual invasion and Gleason 7-10 must be taken into account.
前列腺癌患者在接受根治性外照射放疗时，若治疗前前列腺特异性抗原（PSA）<10 ng/ml，其生化无疾病证据（bNED）控制情况良好，这一点已得到充分证实。本报告确定了治疗前PSA<10 ng/ml患者的失败预测因素。然后，这些预测因素被用于定义bNED控制情况可作比较的有利和不利预后亚组患者。
1987年3月至1994年11月期间，266例T1 - T3NXM0前列腺癌且治疗前PSA值<10 ng/ml的患者接受了根治性外照射放疗。全组患者的中位中心轴剂量和中位随访时间分别为72 Gy（63 - 79 Gy）和48个月（2 - 120个月）。使用Kaplan - Meier方法和对数秩检验单因素评估bNED控制的预测因素，并使用Cox比例风险模型多因素评估。所考虑的协变量包括治疗前PSA、触诊分期、Gleason评分、是否存在神经周围侵犯（PNI）和中心轴剂量。基于多因素结果的独立预测因素随后被用于将患者分为两个预后组，并比较两组的bNED控制情况。bNED失败定义为PSA≥1.5 ng/ml且连续两次测定结果呈上升趋势。
根据治疗前和治疗因素对bNED控制进行的单因素分析表明，Gleason评分为2 - 6分的患者与7 - 10分的患者相比、无神经周围侵犯证据（PNI）的患者与有PNI的患者相比、触诊分期为T1/T2AB的患者与T2C/T3的患者相比，5年bNED控制情况有统计学显著改善。多因素分析表明，Gleason评分（p = 0.0496）、PNI（p = 0.0008）和触诊分期（p = 0.0153）是bNED控制的显著独立预测因素。基于这些因素，患者被分为预后较好组（Gleason 2 - 6分、无PNI且分期为T1/T2AB，n = 172）和预后较差组（Gleason 7 - 10分或有PNI或T2C/T3，n = 94）。两组比较显示，预后较差组的bNED控制率显著较低（5年时分别为74%和91%，p = 0.0024）。
（1）本报告确定Gleason 7 - 10分、存在PNI以及触诊分期T2C/T3是单独接受放疗的治疗前PSA <10 ng/ml患者bNED结局较差的预测因素。（2）具有这些治疗前预后因素的患者可能从辅助治疗或改变治疗方案中获益。（3）为了在放疗和前列腺切除术系列之间进行公平比较，必须考虑神经周围侵犯和Gleason 7 - 10分的分布情况。
