Long-Term Implications of a Positive Posttreatment Biopsy in Patients Treated with External Beam Radiotherapy for Clinically Localized Prostate Cancer.
Long-Term Implications of a Positive Posttreatment Biopsy in Patients Treated with External Beam Radiotherapy for Clinically Localized Prostate Cancer.
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DOI：
10.1097/ju.0000000000000110
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发表时间：
2019-06
期刊：
影响因子：
--
通讯作者：
Fuks Z
中科院分区：
文献类型：
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作者：
Zelefsky MJ;Goldman DA;Reuter V;Kollmeier M;McBride S;Zhang Z;Varghese M;Pei X;Fuks Z
确定前列腺放疗后治疗后活检阳性的预后重要性。382例患者在临床局限性前列腺癌的体外放射治疗（EBRT）后接受了治疗后活检。治疗后活检分为阳性（前列腺腺癌，无典型辐射诱导的变化）、阴性（无癌症证据）或腺癌伴重度治疗效应（STE）。幸存者的中位随访时间为9年。竞争风险回归用于评估预后预测因子与CSM、DM和PSA失败之间的关系。阳性率、治疗效果和阴性活检率分别为30%、22%和48%。雄激素剥夺治疗的遗漏和高危疾病分别与治疗后活检阳性几率增加2.6倍和1.8倍相关。阴性、STE和阳性治疗后活检患者的15年PSA复发率分别为34%、36%和79%（p< 0.001）。在控制了已知的预测因素后，活检阳性患者发生远处转移的风险是阴性和STE活检结果患者的2.6倍（p<0.001），活检阳性患者的病因特异性死亡率是阴性和STE活检结果患者的2倍（HR：2.00，p=0.022）。EBRT后治疗后活检阳性与远处转移和前列腺癌相关死亡的风险较高相关。与阳性活检相比，STE分类活检的患者具有更像阴性活检的生物学特征。在单独EBRT而不使用ADT或存在高风险疾病的情况下，治疗后活检更常呈阳性。
To determine the prognostic importance of a positive post-treatment biopsy after prostate radiotherapy. 382 patients underwent a post-treatment biopsy after external beam radiotherapy (EBRT) for clinically localized prostate cancer. Post-treatment biopsies were classified as positive (prostatic adenocarcinoma without typical radiation–induced changes), negative (no evidence of carcinoma) or adenocarcinoma with severe treatment effect (STE). The median follow-up in survivors was 9 years. Competing risks regression was used to assess relationship between prognostic predictors and CSM, DM, and PSA failure. The prevalence of a positive, treatment effect and negative biopsy were 30%, 22% and 48%, respectively. Omission of androgen deprivation therapy and high-risk disease were associated with a 2.6 and 1.8-fold increase in odds of positive post-treatment biopsy, respectively. The 15-year PSA-relapse rates for negative, STE and positive post-treatment biopsy patients were 34%, 36% and 79%, respectively (p< 0.001). After controlling for known predictors, the hazard of distant metastases was 2.6-fold higher for positive biopsy patients (p<0.001) and cause-specific mortality was twice as high (HR: 2.00, p=0.022) in those with positive biopsy as compared to patients with negative and STE biopsy outcomes. A positive post-treatment biopsy after EBRT was associated with a higher hazard of distant metastases and prostate cancer related death. Patients with STE- classified biopsies have biologic characteristics more like those with a negative biopsy compared to a positive biopsy. Post-treatment biopsies were more often positive in the setting of EBRT alone without ADT or in the presence of high-risk disease.