The relationship between biochemical failure and time to nadir in patients treated with external beam therapy for T1-T3 prostate carcinoma
The relationship between biochemical failure and time to nadir in patients treated with external beam therapy for T1-T3 prostate carcinoma
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DOI：
10.1016/s0167-8140(98)00061-9
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发表时间：
1998-08-01
影响因子：
5.7
通讯作者：
Cross, P
中科院分区：
文献类型：
--
作者：
Aref, I;Eapen, L;Cross, P
目的和背景：确定前列腺特异性抗原（PSA）的最低点值和到达最低点的时间，以预测前列腺癌患者接受外束治疗后免于生化失败的高概率。材料和方法：在1990年1月至1994年3月期间，228例T1-T3前列腺癌患者接受了根治性外束照射，未接受任何先前或辅助激素治疗。所有男性均进行治疗前和治疗后血清PSA评估，并随访至少24个月，以确保PSA达到最低点。生化失败定义为治疗后血清PSA连续三次升高，无论升高幅度如何。结果：总体而言，4年生化无病生存率（BDFS）为42%。PSA最低点可预测随后的BDFS。对于血清PSA最低值小于或等于1 ng/ml的患者，4年BDFS为70%，而血清PSA最低值为1 ng/ml的患者为12% （P = < 0.001）。至最低点时间小于或等于1年的患者4年BDFS为28%，而至最低点时间为10年的患者为58% （P < 0.001）。对于PSA最低点小于或等于1 ng/ml的患者，至最低点时间为1年的患者4年BDFS为75%，而至最低点时间小于或等于1年的患者为61% （P < 0.021）。在多变量分析中，PSA最低点（小于或等于1ng /ml vs小于1ng /ml）和到达最低点的时间（小于或等于1年vs小于1ng /ml）是单独治疗前PSA和Gleason评分的BDFS的独立预测因子。结论：体外束流治疗后PSA最低点小于等于1ng /ml者有较好的机会获得持续的生化疾病控制，而PSA最低点小于等于1ng /ml者有较高的后续失败率。发病时间较晚的患者预后较好。除PSA降至最低点外，降至最低点的时间、预处理PSA和Gleason评分也具有独立的预后意义。(C) 1998爱思唯尔科学爱尔兰有限公司版权所有。
Purpose and background: To determine a prostatic-specific antigen (PSA) nadir value and time to nadir that predict a high probability of freedom from biochemical failure in men treated with external beam therapy for prostate cancer. Materials and methods: Between January 1990 and March 1994, 228 men with T1-T3 adenocarcinoma of the prostate received a radical course of external beam irradiation with no prior or adjuvant hormonal therapy. All men had pre- and post-treatment serum PSA evaluations, and were followed up for at least 24 months, to ensure PSA nadir was reached. Biochemical failure was defined as three successive post-treatment rises in serum PSA, regardless of the magnitude of elevation. Results: Overall, 4-year biochemical disease-free survival (BDFS) was 42%. PSA nadir was predictive of subsequent BDFS. For those whose serum PSA nadir was less than or equal to 1 ng/ml, 4-year BDFS was 70%, versus 12% for those with serum PSA nadir >1 ng/ml (P = < 0.001). The 4-year BDFS for patients with time to nadir less than or equal to 1 year, was 28%, versus 58% for those with time to nadir >1 year (P < 0.001). For patients with PSA nadir less than or equal to 1 ng/ml, 4-year BDFS was 75% for those with time to nadir >1 year, versus 61% for those with time to nadir less than or equal to 1 year (P < 0.021). In multivariate analysis, PSA nadir (less than or equal to 1 ng/ml versus >1 ng/ml, and time to nadir (less than or equal to 1 year versus >1 year) were independent predictors of BDFS alone with pre-treatment PSA and Gleason score. Conclusion: Only those who achieved PSA nadir less than or equal to 1 ng/ml following external beam therapy have a favourable chance of lasting biochemical disease control, while those with nadir >1 ng/ml have a high subsequent failure rate. The prognosis is better in patients with late time to nadir. In addition to PSA nadir, time to nadir, pretreatment PSA, and Gleason score were of independent prognostic significance. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.