Defining prostate specific antigen progression after radical prostatectomy: What is the most appropriate cut point?
Defining prostate specific antigen progression after radical prostatectomy: What is the most appropriate cut point?
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DOI：
10.1016/s0022-5347(05)66452-x
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发表时间：
2001-04-01
影响因子：
6.6
通讯作者：
Zincke, H
中科院分区：
文献类型：
--
作者：
Amling, CL;Bergstralh, EJ;Zincke, H
目的：根治性乳腺癌切除术和放射治疗后生化进展的最适当定义尚不确定。我们分析了使用各种前列腺特异性抗原（PSA）终点定义来定义根治性前列腺切除术后生化进展的效果，并试图确定最佳PSA临界点。美国放射治疗与肿瘤学会（ASTRO）的放射治疗后的生化失败的定义方面也进行了分析，在我们的根治性前列腺癌cases.Materials和方法：共2,782例临床局限性前列腺癌（CT 1-T2）谁经历了根治性前列腺癌切除术在1987年和1993年之间进行了审查。所有患者从手术到随访期间定期进行PSA测定。分析仅限于根治性前列腺切除术后90天内未接受辅助治疗的患者。采用Kaplan-Meier法测定根治性前列腺切除术后生化指标、PSA进展未缓解率，PSA临界值分别为0.2、0.3、0.4和0.5 ng。ml.或更大，以及0.4ng./ ml.或更大，并不断增加。还使用ASTRO定义评估了无进展百分比，即PSA增加3。为了确定哪种PSA水平最适合定义根治性前列腺切除术后的进展，确定了达到每个临界点后PSA持续升高的患者百分比。手术后3年内最大PSA值与随后临床疾病发展之间的关系也进行了评估。结果：无进展百分比取决于所用的PSA临界点。临界点0.2、0.3、0.4和0.5 ng的生化无进展百分比。/ ml.≥ 5年时分别为62%、72%、76%和78%，10年时分别为43%、54%、59%和61%。在PSA <0.2、0.3和0.4 ng的患者中，分别有49%、62%和72%的患者随后PSA升高。ml.，分别随后的临床进展（局部或全身）与根治性前列腺切除术后3年内达到的最大PSA直接相关（p = 0.0001）。需要PSA多次升高定义的无进展百分比取决于事件发生的时间。在第一次PSA（ASTRO定义）或之前回溯事件导致短期无进展百分比更差（5年时为78%），几乎没有明显的长期失败可能性（10年时为78%）。在最后一次PSA升高时，当所有事件标准都得到满足时，对事件进行编码，可获得更现实的无进展百分比估计值（5年时为85%，10年时为59%）。结论：生化、PSA进展率根据定义PSA失败的方法而显著不同。需要多次增加PSA值的方法，例如ASTRO定义，会产生误导性结果，特别是如果事件时间回溯。定义PSA进展的标准将允许根治性前列腺切除术后更一致和可比的进展估计。PSA 0.4 ng/ ml.或更高可能是最合适的临界点，因为大量PSA较低的患者PSA没有持续升高。
Purpose: The most appropriate definition of biochemical progression after radical prostatectomy and radiation therapy is uncertain. We analyzed the effect of using various prostate specific antigen (PSA) end point definitions for defining biochemical progression after radical prostatectomy and attempted to determine the best PSA cut point to use. Aspects of the American Society for Therapeutic Radiology and Oncology (ASTRO) definition of biochemical failure after radiation therapy are also analyzed in our radical prostatectomy cases.Materials and Methods: A total of 2,782 men with clinically localized prostate cancer (cT1-T2) who had undergone radical prostatectomy between 1987 and 1993 were reviewed. All patients had regular PSA determinations from surgery through followup. Analysis was limited to patients who did not receive adjuvant treatment within 90 days of radical prostatectomy. Biochemical, PSA progression-fi ee percent after radical prostatectomy was determined by the Kaplan-Meier method using several PSA cut points, including 0.2, 0.3, 0.4 and 0.5 ng./ml. or greater, as well as 0.4 ng./ml. or greater and increasing. Progression-free percent was also assessed using the ASTRO definition, which is 3 increases in PSA. To determine which PSA level was most appropriate to define progression after radical prostatectomy, the percentage of patients with a continued PSA increase after reaching each cut point was determined. The relationship between the maximum PSA within 3 years of surgery and subsequent development of clinical disease was also assessed.Results: Progression-free percent was dependent on the PSA cut point used. Biochemical progression-free percentages for cut points 0.2, 0.3, 0.4 and 0.5 ng./ml. or greater were 62%, 72%, 76% and 78% at 5 years, and 43%, 54%, 59% and 61% at 10 years, respectively. A subsequent increase in PSA was noted in 49%, 62% and 72% of patients who had PSA 0.2, 0.3 and 0.4 ng./ml., respectively. Subsequent clinical progression (local or systemic) was directly related to the maximum PSA attained within 3 years of radical prostatectomy (p = 0.0001). Progression-free percent for definitions requiring multiple increases in PSA were dependent on when the event was said to occur. Backdating of events at or before the first PSA (ASTRO definition) resulted in poorer, short-term progression-free percent (78% at 5 years), with little apparent Likelihood of long-term failure (78% at 10 years). Coding the event at the last PSA increase when all event criteria had been met resulted in more realistic progression-free percent estimates (85% at 5 and 59% at 10 years).Conclusions: Biochemical, PSA progression rates vary markedly depending on the method used to define PSA failure. Methods that require multiple increasing PSA values, for example the ASTRO definition, give misleading results, especially if the event time is backdated. Standards for defining PSA progression would allow more consistent and comparable progression estimates after radical prostatectomy. PSA 0.4 ng./ml. or greater may be the most appropriate cut point to use since a significant number of patients with lower PSA do not have a continued increase in it.