Defining biochemical recurrence of prostate cancer after radical prostatectomy: A proposal for standardized definition
Defining biochemical recurrence of prostate cancer after radical prostatectomy: A proposal for standardized definition
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DOI：
10.1200/jco.2005.04.0756
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发表时间：
2006-08-20
影响因子：
45.3
通讯作者：
Scardino, Peter T.
中科院分区：
文献类型：
--
作者：
Stephenson, Andrew J.;Kattan, Michael W.;Scardino, Peter T.
目的前列腺特异性抗原（PSA）定义的前列腺癌生化复发（BCR）被广泛用于报告根治性前列腺切除术（RP）的预后。缺乏标准化的BCR定义，总体无进展概率和随后转移性疾病进展的风险可能因所用的PSA标准而有很大差异。我们评估了10种BCR定义，以确定最能解释转移进展的定义。方法：自1985年以来在我院接受RP治疗的3125例患者中，75例在49个月的中位随访期间发生远处转移。为了预测转移进展，我们使用多变量Cox回归分析对临床信息进行建模。BCR作为随时间变化的协变量包含在模型中，并为每个定义开发了单独的模型。采用拟合优度（R-2）统计来确定最能解释转移进展的Cox模型（从而确定BCR的定义）。根据BCR的定义，10年无进展概率从63%到79%不等。包含BCR的模型定义为PSA至少为0.4 ng/mL，随后出现另一次增加，最好地解释了转移进展（R-2 = 0.21）。这一定义也与后续二次治疗的高概率、持续的PSA进展和快速的PSA倍增时间有关。结论在控制临床变量和使用二次治疗后，BCR定义为PSA值至少为0.4 ng/mL，然后再增加，最好地解释了10个候选定义中的远处转移的发生。基于这一证据，我们建议采用这一定义作为报告RP结果的标准。
Purpose Prostate-specific antigen (PSA) defined biochemical recurrence (BCR) of prostate cancer is widely used for reporting the outcome of radical prostatectomy (RP). A standardized BCR definition is lacking, and overall progression-free probability and risk of subsequent metastatic disease progression may vary greatly depending on the PSA criterion used. Ten definitions of BCR were evaluated to identify the one that best explains metastatic progression.Methods Of 3,125 patients who underwent RP at our institution since 1985, 75 developed distant metastasis during a median follow-up of 49 months. To predict metastasis progression, we modeled the clinical information using multivariable Cox regression analysis. BCR was included in the model as a time-dependent covariate, and separate models were developed for each definition. A goodness-of-fit (R-2) statistic was used to determine the Cox model (and thereby the BCR definition) that best explained metastatic progression.Results The 10-year progression-free probability ranged from 63% to 79%, depending on the BCR definition. The model containing BCR defined as a PSA of at least 0.4 ng/mL followed by another increase best explained metastatic progression (R-2 = 0.21). This definition was also associated with a high probability of subsequent secondary therapy, continued PSA progression, and rapid PSA doubling time.Conclusion BCR defined as a PSA value of at least 0.4 ng/mL followed by another increase best explains the development of distant metastasis among 10 candidate definitions, after controlling for clinical variables and the use of secondary therapy. On the basis of this evidence, we propose that this definition be adopted as the standard for reporting the outcome of RP.