The natural history and predictors of outcome following biochemical relapse in the dose escalation era for prostate cancer patients undergoing definitive external beam radiotherapy.
The natural history and predictors of outcome following biochemical relapse in the dose escalation era for prostate cancer patients undergoing definitive external beam radiotherapy.
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DOI：
10.1016/j.eururo.2014.09.028
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发表时间：
2015-06
期刊：
影响因子：
23.4
通讯作者：
Zelefsky, Michael J.
中科院分区：
文献类型：
--
作者：
Zumsteg, Zachary S.;Spratt, Daniel E.;Romesser, Paul B.;Pei, Xin;Zhang, Zhigang;Polkinghorn, William;McBride, Sean;Kollmeier, Marisa;Yamada, Yoshiya;Zelefsky, Michael J.
前列腺癌体外放射治疗（EBRT）后生化衰竭（BF）的管理存在争议，因为BF后的疾病过程异质性和缺乏这种情况下的临床试验。我们试图描述一个接受明确剂量递增EBRT的局限性前列腺癌男性大队列中发生BF患者的自然史和结局预测因素。这项回顾性分析包括在一个大型学术中心接受EBRT治疗的2694例局限性前列腺癌患者。其中，609例发生BF，定义为前列腺特异性抗原（PSA）最低值+ 2 ng/ml。所有患者的中位随访时间为83个月，BF患者为122个月。所有患者均接受了EBRT，剂量为75.6-86.4戈伊。本研究的主要目的是确定BF时远处进展的预测因素。采用考克斯比例风险模型对远处转移（DM）进行单变量和多变量分析，采用竞争风险法分析前列腺癌特异性死亡率（PCSM）。从BF之日起，至DM和PCSM死亡的中位时间分别为5.4年和10.5年。较短的治疗后PSA倍增时间，较高的初始临床肿瘤分期，较高的治疗前Gleason评分，以及从放疗结束到BF的较短时间间隔是BF后临床进展的独立预测因素。有两个危险因素的患者BF后DM和PCSM的发生率显著高于无或有一个危险因素的患者。本研究的主要局限性是其回顾性和异质性挽救干预。临床和病理因素可以帮助识别BF后临床进展的高风险患者。在这篇报道中，我们研究了放射治疗后前列腺癌复发患者的预后预测因素，如前列腺特异性抗原（PSA）水平。我们发现，在这种情况下，前列腺癌患者发生远处转移和死亡的中位时间分别为5年和10年。此外，我们发现，治疗后PSA水平快速升高、PSA复发时间短、前列腺外器官浸润或Gleason评分高的患者预后较差。
The management of biochemical failure (BF) following external beam radiotherapy (EBRT) for prostate cancer is controversial, due to both the heterogeneous disease course following a BF and a lack of clinical trials in this setting. We sought to characterize the natural history and predictors of outcome for patients experiencing BF in a large cohort of men with localized prostate cancer undergoing definitive dose-escalated EBRT. This retrospective analysis included 2694 patients with localized prostate cancer treated with EBRT at a large academic center. Of these, 609 experienced BF, defined as prostate-specific antigen (PSA) nadir + 2 ng/ml. The median follow-up was 83 mo for all patients and 122 mo for BF patients. All patients received EBRT at doses of 75.6–86.4 Gy. The primary objective of this study was to determine predictors of distant progression at the time of BF. Cox proportional hazards models were used in univariate and multivariate analyses of distant metastases (DM), and a competing risks method was used to analyze prostate cancer–specific mortality (PCSM). From the date of BF, the median times to DM and PCSM mortality were 5.4 yr and 10.5 yr, respectively. Shorter posttreatment PSA doubling time, a higher initial clinical tumor stage, a higher pretreatment Gleason score, and a shorter interval from the end of radiotherapy to BF were independent predictors for clinical progression following BF. Patients with two of these risk factors had a significantly higher incidence of DM and PCSM following BF than those with zero or one risk factor. The main limitations of this study are its retrospective nature and heterogeneous salvage interventions. Clinical and pathologic factors can help identify patients at high risk of clinical progression following BF. In this report, we look at predictors of outcome for patients with prostate cancer recurrence, as determined by prostate-specific antigen (PSA) levels, following radiation treatment. We found that the approximate median times to distant metastasis and death from prostate cancer for patients in this situation were 5 yr and 10 yr, respectively. Furthermore, we found that patients with a rapid increase in PSA levels following treatment, a short time to PSA recurrence, invasion of extraprostatic organs, or a high Gleason score had worse outcomes.
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影响因子：
254.7
作者：
Siegel, Rebecca;Ma, Jiemin;Jemal, Ahmedin
通讯作者：
Jemal, Ahmedin
DOI：
10.1016/j.ijrobp.2011.10.077
发表时间：
2012-09-01
影响因子：
7
作者：
Goenka, Anuj;Magsanoc, Juan Martin;Zelefsky, Michael J.
通讯作者：
Zelefsky, Michael J.
DOI：
10.1093/jnci/djg043
发表时间：
2003-09-17
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
D'Amico, AV;Moul, JW;Chen, MH
通讯作者：
Chen, MH
影响因子：
45.3
作者：
Stephenson, AJ;Eastham, JA
通讯作者：
Eastham, JA
影响因子：
2.1
作者：
Nielsen, Matthew E.;Makarov, Danil V.;Walsh, Patrick C.
通讯作者：
Walsh, Patrick C.