Pretreatment predictors of time to cancer specific death after prostate specific antigen failure
Pretreatment predictors of time to cancer specific death after prostate specific antigen failure
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DOI：
10.1097/01.ju.0000049200.30192.d1
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发表时间：
2003-04-01
影响因子：
6.6
通讯作者：
Chen, MH
中科院分区：
文献类型：
--
作者：
D'Amico, AV;Cote, K;Chen, MH
用途：本研究的主题是，对于在PSA时代接受治疗的有竞争性死亡原因的患者，预测至前列腺特异性抗原（PSA）治疗失败时间的治疗前因素是否也预测PSA治疗失败后至前列腺癌特异性死亡的时间。材料和方法：在1988年至2001年间因临床局限性前列腺癌而接受外照射放射治疗的415名中位年龄为73岁的男性中，160名（39%）PSA失败，96例（23%）死亡。46名男性（48%）的死因是前列腺癌。考克斯回归多变量分析（多变量分析）来评估治疗前PSA和集中审查的活检Gleason评分预测PSA失败后前列腺癌特异性死亡时间的能力。当使用多变量分析作为分类变量进行分析时，活检Gleason评分4 + 3（p = 0.02），8 - 10（p = 0.02）例疾病和治疗前PSA大于20 ng。/ ml.（p = 0.03）是PSA失败后前列腺癌特异性死亡时间的显著预测因素。对于活检Gleason评分为56、3 + 4、4 + 3或更高的患者，PSA失败后5年的前列腺癌特异性死亡估计值分别为24%、40%和59%（p = 0.01），对于治疗前PSA为10或更低、大于10且20或更低或大于20 ng的患者，分别为22%、40%和60%（p = 0.04）。ml.，结论：基于治疗前PSA大于20 ng，放射治疗后PSA失败的高风险患者。ml.或活检Gleason评分为4 + 3或更高的患者在PSA失败后也处于前列腺癌死亡的高风险中，尽管存在死亡的竞争原因。
Purpose: Whether pretreatment factors that predict for time to prostate specific antigen (PSA) failure also predict for time to prostate cancer specific death after PSA failure for patients with competing causes of mortality treated during the PSA era was the subject of this study.Materials and Methods: Of 415 men with a median age of 73 years who underwent external beam radiation therapy between 1988 and 2001 for clinically localized prostate cancer 160 (39%) experienced PSA failure and 96 (23%) died. In 46 men (48%) the cause of death was prostate cancer. Cox regression multivariable analyses (multivariable analysis) were performed to evaluate the ability of the pretreatment PSA and centrally reviewed biopsy Gleason score to predict time to prostate cancer specific death after PSA failure.Results: When analyzed as categorical variables using multivariable analysis, biopsy Gleason score 4 + 3 (p = 0.02), 8 to 10 (p = 0.02) disease and a pretreatment PSA greater than 20 ng./ml. (p = 0.03) were significant predictors of time to prostate cancer specific death after PSA failure. Estimates of prostate cancer specific death 5 years after PSA failure were 24%, 40% and 59% (p = 0.01) for patients with a biopsy Gleason score :56, 3 + 4, 4 + 3 or higher and 22%, 40% and 60% (p = 0.04) for patients with a pretreatment PSA of 10 or less, greater than 10 and 20 or less, or greater than 20 ng./ml., respectively.Conclusions: Patients at high risk for PSA failure after radiation therapy based on pretreatment PSA greater than 20 ng./ml. or biopsy Gleason score 4 + 3 or greater are also at high risk for death from prostate cancer after PSA failure despite competing causes of mortality.