Zelefsky M J, Lyass O, Fuks Z, Wolfe T, Burman C, Ling C C, Leibel S A
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021-6007, USA.
J Clin Oncol. 1998 Oct;16(10):3380-5. doi: 10.1200/JCO.1998.16.10.3380.
To identify prognostic variables that predict for improved biochemical and local control outcome in patients with localized prostatic cancer treated with neoadjuvant androgen deprivation (NAAD) and three-dimensional conformal radiotherapy (3D-CRT).
Between 1989 and 1995, 213 patients with localized prostate cancer were treated with a 3-month course of NAAD that consisted of leuprolide acetate and flutamide before 3D-CRT. The purpose of NAAD in these patients was to reduce the preradiotherapy target volume so as to decrease the dose delivered to adjacent normal tissues and thereby minimize the risk of morbidity from high-dose radiotherapy. The median pretreatment prostate-specific antigen (PSA) level was 15.3 ng/mL (range, 1 to 560 ng/mL). The median 3D-CRT dose was 75.6 Gy (range, 64.8 to 81 Gy), and the median follow-up time was 3 years (range, 1 to 7 years).
The significant predictors for improved outcome as identified in a multivariate analysis included pretreatment PSA level < or = 10.0 ng/mL(P < .00), NAAD-induced preradiotherapy PSA nadir < or = 0.5 ng/mL (P < .001), and clinical stage < or = T2c (P < .04). The 5-year PSA relapse-free survival rates were 93%, 60%, and 40% for patients with pretreatment PSA levels < or = 10 ng/mL, 10 to 20 ng/mL, and greater than 20 ng/mL, respectively (P < .001). Patients with preradiotherapy nadir levels < or = 0.5 ng/mL after 3 months of NAAD experienced a 5-year PSA relapse-free survival rate of 74%, as compared with 40% for patients with higher nadir levels (P < .001). The incidence of a positive biopsy among 34 patients pretreated with androgen ablation was 12%, as compared with 39% for 117 patients treated with 3D-CRT alone who underwent a biopsy (P < .001).
For patients treated with NAAD and high-dose 3D-CRT, pretreatment PSA, preradiotherapy PSA nadir response, and clinical stage are important predictors of biochemical outcome. Patients with NAAD-induced PSA nadir levels greater than 0.5 ng/mL before radiotherapy are more likely to develop biochemical failure and may benefit from more aggressive therapies.
确定在接受新辅助雄激素剥夺（NAAD）和三维适形放疗（3D-CRT）治疗的局限性前列腺癌患者中，能够预测生化指标改善和局部控制效果的预后变量。
1989年至1995年间，213例局限性前列腺癌患者在进行3D-CRT之前接受了为期3个月的NAAD治疗，该治疗由醋酸亮丙瑞林和氟他胺组成。这些患者接受NAAD的目的是减少放疗前的靶体积，从而降低输送到相邻正常组织的剂量，进而将高剂量放疗导致的发病风险降至最低。治疗前前列腺特异性抗原（PSA）水平的中位数为15.3 ng/mL（范围为1至560 ng/mL）。3D-CRT剂量的中位数为75.6 Gy（范围为64.8至81 Gy），中位随访时间为3年（范围为1至7年）。
多变量分析确定的预后改善的显著预测因素包括治疗前PSA水平≤10.0 ng/mL（P <.00）、NAAD诱导的放疗前PSA最低点≤0.5 ng/mL（P <.001）以及临床分期≤T2c（P <.04）。治疗前PSA水平≤10 ng/mL、10至20 ng/mL以及大于20 ng/mL的患者，其5年无PSA复发生存率分别为93%、60%和40%（P <.001）。接受3个月NAAD治疗后放疗前最低点水平≤0.5 ng/mL的患者，其5年无PSA复发生存率为74%，而最低点水平较高的患者为40%（P <.001）。34例接受雄激素消融预处理的患者中，活检阳性的发生率为12%；相比之下，117例仅接受3D-CRT治疗并接受活检的患者中该发生率为39%（P <.001）。
对于接受NAAD和高剂量3D-CRT治疗的患者，治疗前PSA、放疗前PSA最低点反应以及临床分期是生化指标预后的重要预测因素。放疗前NAAD诱导的PSA最低点水平大于0.5 ng/mL的患者更易发生生化失败，可能从更积极的治疗中获益。
