Equivalent biochemical failure-free survival after external beam radiation therapy or radical prostatectomy in patients with a pretreatment prostate specific antigen of >4-20 ng/ml
Equivalent biochemical failure-free survival after external beam radiation therapy or radical prostatectomy in patients with a pretreatment prostate specific antigen of >4-20 ng/ml
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DOI：
10.1016/s0360-3016(96)00633-5
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发表时间：
1997-03-15
影响因子：
7
通讯作者：
Coleman, CN
中科院分区：
文献类型：
--
作者：
DAmico, AV;Whittington, R;Coleman, CN
目的：通过预处理前列腺特异性抗原（PSA）和活检Gleason评分（bGl）来确定前列腺癌患者的无生化失败生存率，这些患者最终接受了外束放射治疗或根治性耻骨后前列腺切除术。方法和材料：采用Cox回归多变量分析，评估PSA、bGl和临床分期变量，分别评估867例和757例连续接受外束放射治疗或根治性耻骨后前列腺切除术的前列腺癌患者PSA失效的终点时间。使用Kaplan-Meier分析确定PSA无失败生存期。采用对数秩检验进行比较。结果：使用Cox回归多变量分析发现，术前PSA、bGl和临床分期（T3,4 vs. T1,T2）是手术和放疗患者治疗后PSA失效时间的独立预测因子。治疗前PSA为> 4 ng/ml且小于或等于20 ng/ml的患者可根据治疗后PSA失效的时间分为危险组：低= PSA > 4-10 ng/ml且bGl小于或等于4；中间= PSA > 4-10和bGl 5-7；或PSA≤10 ~ 20 ng/ml，且bGl≤7；高= PSA > 4 ~ 20ng /ml， bGl大于等于8。在治疗后PSA失败的低、中、高风险患者中，手术治疗和放疗患者的两年PSA无失败生存率分别为98%对92% (p = 0.45)， 77%对81% (p = 0.86)， 51%对53% （p = 0.48）。结论：当对预处理PSA和bGl进行回顾性分层比较时，通过手术或放射治疗明确治疗的潜在可治愈患者的2年PSA无失败生存率无统计学差异。(C) 1997爱思唯尔科学有限公司
Purpose: Biochemical failure-free survival stratified by the pretreatment prostate-specific antigen (PSA) and biopsy Gleason score (bGl) is determined for prostate cancer patients managed definitively with external beam radiation therapy or radical retropubic prostatectomy.Methods and Materials: A Cox regression multivariable analysis evaluating the variables of PSA, bGl, and clinical stage was used to evaluate the end point of time to PSA failure in 867 and 757 consecutive prostate cancer patients managed definitively with external beam radiation therapy or radical retropubic prostatectomy, respectively. PSA failure-free survival was determined using Kaplan-Meier analysis. Comparisons were made using the log rank test.Results: The pretreatment PSA, bGl, and clinical stage (T3,4 vs. T1,T2) were found to be independent predictors of time to post-treatment PSA failure for both surgically and radiation managed patients using Cox regression multivariable analysis. Patients with a pretreatment PSA of > 4 ng/ml and less than or equal to 20 ng/ml could be classified into risk groups for time to post-therapy PSA failure: low = PSA > 4-10 ng/ml and bGl less than or equal to 4; intermediate = PSA > 4-10 and bGl 5-7; or PSA > 10-20 ng/ml and bGl less than or equal to 7; high = PSA > 4-20 ng/ml and bGl greater than or equal to 8. Two-year PSA failure-free survival for surgically managed and radiation-managed patients, respectively, were 98% vs. 92% (p = 0.45), 77% vs. 81% (p = 0.86), and 51% vs. 53% (p = 0.48) for patients at low, intermediate, and high risk for post-therapy PSA failure.Conclusions: There was no statistical difference in the 2-year PSA failure-free survival for potentially curable patients managed definitively with surgery or radiation therapy when a retrospective comparison stratifying for the pretreatment PSA and bGl was performed. (C) 1997 Elsevier Science Inc.