Parameters derived from the postoperative decline in ultrasensitive PSA improve the prediction of radical prostatectomy outcome
Parameters derived from the postoperative decline in ultrasensitive PSA improve the prediction of radical prostatectomy outcome
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DOI：
10.1007/s00345-012-0892-3
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发表时间：
2013-04-01
影响因子：
3.4
通讯作者：
Babjuk, Marko
中科院分区：
文献类型：
--
作者：
Vesely, Stepan;Jarolim, Ladislav;Babjuk, Marko
目前估计前列腺癌根治术(RP)后复发风险增加的工具还很不完善，人们一直在密集寻找其他预测变量。为了探讨术后超敏前列腺特异性抗原(PSA)下降的参数是否能为预测前列腺癌的进展提供额外的信息。共有319名连续的男性患者接受了这项研究，他们接受了临床局限性前列腺癌RP术后至少2年的随访。术后对超敏感的PSA进行了密集的测量，总共有4028个PSA值可用于统计评估。生化复发(BCR)定义为PSA千分之0.2 ng/ml。预测模型的准确性用曲线下面积来量化。中位随访43个月(24-99个月)，107例(34%)患者在RP后发生BCR。在bcr患者中，观察到显著更高的PSA值(p<；0.001)和更短的从手术到PSA值的时间间隔(p<；0.001)。多因素COX回归分析表明，PSA水平为0.01 ng/ml(HR 6.01，95%CI：3.89~9.52)和PSA下降时间为3个月(HR 2.86，95%CI：1.74~5.01)是BCR的独立预测因素。在模型中加入PSA最低点和PSA最低点时间，使得预测准确率比根据已建立的参数设计的模型提高了16%。我们的结果表明，超敏试验测定的PSA最低点水平和PSA最低点达到最低点的时间显著提高了对高危患者的识别能力。
Contemporary tools estimating increased risk of prostate cancer (PCa) relapse after radical prostatectomy (RP) are far from perfect and there has been an intensive search for additional predictive variables. We aimed to explore whether the parameters of postoperative ultrasensitive prostate-specific antigen (PSA) decline provide additional information for predicting PCa progression.A total of 319 consecutive men, with at least 2 years of follow-up after RP for clinically localized PCa were subjected to this study. Intensive postoperative measurements of ultrasensitive PSA resulted in total of 4028 PSA values available for statistical evaluation. Biochemical recurrence (BCR) was defined as PSA a parts per thousand yen0.2 ng/ml. The accuracy of predictive models was quantified with the area under the curve.Over a median follow-up of 43 months (24-99 months), 107 patients (34 %) experienced BCR after RP. In patients with BCR, significantly higher values of PSA nadir (p < 0.001) and a decreased time interval from surgery to reach PSA nadir (p < 0.001) were observed. A multivariable Cox regression model confirmed that PSA nadir > 0.01 ng/ml (HR 6.01, 95 % CI: 3.89-9.52) and time to PSA nadir < 3 months (HR 2.86, 95 % CI: 1.74-5.01) were independent predictors of BCR. The inclusion of PSA nadir and the time to PSA nadir into the model resulted in improvement of predictive accuracy by 16 % over the model designed on the basis of established parameters.Our results demonstrate that the level of PSA nadir and the time to PSA nadir determined by ultrasensitive assay significantly improve the identification of patients who are at high risk of disease recurrence after RP.