Natural history of disease progression in patients who fail to achieve an undetectable prostate-specific antigen level after undergoing radical prostatectomy
Natural history of disease progression in patients who fail to achieve an undetectable prostate-specific antigen level after undergoing radical prostatectomy
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DOI：
10.1002/cncr.20637
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发表时间：
2004-12-01
期刊：
影响因子：
6.2
通讯作者：
Partin, AW
中科院分区：
文献类型：
--
作者：
Rogers, CG;Khan, MA;Partin, AW
背景资料。据作者所知，在根治性耻骨后前列腺切除术(RRP)后未能达到无法检测到的前列腺特异性抗原(PSA)水平的男性中，疾病进展到远处转移的自然病史是未知的。作者评估了经RRP治疗临床局限性前列腺癌后持续可检测到PSA水平的男性的临床结果。方法：1989至2002年间，160名男性在接受RRP治疗临床局限性前列腺癌后未能达到不可检测的PSA水平(大于或等于0.1 ng/mL)。在证实有转移之前，没有患者接受辅助治疗。采用Kaplan-Meier方法估计无远处转移生存率。用单因素和多因素Cox比例风险回归分析临床和病理变量预测无远处转移生存率的能力。结果：3年、5年和10年无远处转移生存率的概率分别为68%、49%和22%。75名男性(47%)在RRP后发生远处转移(中位转移时间为5.0年；范围为0.5-13年)。RRP Gleason评分、精囊状态和淋巴转移状态的组合导致了预测无远处转移生存的3个风险组(危险比[HR]=1.6；P<；0.01)。PSA斜率在RRP后约3-12个月的变化被发现更能预测无远处转移生存期(HR=2.9；P<；0.01)。结论：许多患者在接受RRP治疗临床局限性前列腺癌后，虽然未能达到检测不到的PSA水平，但在较长时间内仍无转移。然而，其他患者经历了疾病快速进展到远处转移。作者定义了临床(PSA斜率)和病理(Gleason评分)预后变量，以帮助识别接受RRP后发生远处转移风险较高的患者。(C)2004年美国癌症协会。
BACKGROUND. To the authors' knowledge, the natural history of disease progression to distant metastasis is unknown in men who fail to achieve an undetectable prostate-specific antigen (PSA) level after radical retropubic prostatectomy (RRP),. The authors assessed the clinical outcome of men with a persistently detectable PSA level after RRP for clinically localized prostate carcinoma.METHODS. Between 1989 and 2002, 160 men failed to achieve an undetectable PSA level ( greater than or equal to 0.1 ng/mL) after undergoing RRP for clinically localized prostate carcinoma. No patient received adjuvant therapy before documented metastasis. The Kaplan-Meier method was used to estimate distant metastasis-free survival. Univariate and multivariate Cox proportional hazards regression was used to assess the ability of clinical and pathologic variables to predict distant metastasis-free survival.RESULTS. The probability of distant metastasis-free survival at 3 years, 5 years, and 10 years was reported to be 68%, 49%, and 22%, respectively. Seventy-five men (47%) developed distant metastases after RRP (median time to metastases of 5.0 years; range, 0.5-13 years). The combination of RRP Gleason score, seminal vesicle status, and lymph node status resulted in 3 risk groups for the prediction of distant metastasis-free survival (hazards ratio [HR] = 1.6; P < 0.01). The slope of PSA changes approximately 3-12 months after RRP at a cutoff value greater than or equal to 0.05 was found to be even more predictive of distant metastasis-free survival (HR = 2.9; P < 0.01).CONCLUSIONS. Many patients remained free of metastatic disease for an extended period despite failing to achieve an undetectable PSA level after undergoing RRP for clinically localized prostate carcinoma. However, other patients experienced rapid disease progression to distant metastasis. The authors defined clinical (PSA slope) and pathologic (Gleason score) prognostic variables to help identify those patients with a higher risk of developing distant metastasis after undergoing RRP. (C) 2004 American Cancer Society.