Potential survival advantage with early androgen deprivation for biochemical failure after external beam radiotherapy: The importance of accurately defining biochemical disease status
Potential survival advantage with early androgen deprivation for biochemical failure after external beam radiotherapy: The importance of accurately defining biochemical disease status
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DOI：
10.1016/j.ijrobp.2004.03.013
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发表时间：
2004-10-01
影响因子：
7
通讯作者：
Martinez, AA
中科院分区：
文献类型：
--
作者：
Kestin, LL;Vicini, FA;Martinez, AA
目的：我们分析了我们治疗局限性前列腺癌的经验，以确定雄激素剥夺（AD）在孤立性生化失败（BF）时与临床失败后给药对临床结局的影响（临床失败），以及各种BF定义的相关影响。共有1，201例T1-T3 N 0 M0期前列腺癌患者接受了中位剂量为66.6戈伊的外照射放疗（EBRT）。早期AD定义为BF后AD给药，无临床失败证据。延迟性AD定义为临床失败后给予AD。测试了多个BF定义预测后续临床失败的能力。对于每个BF定义，结果进行了比较BF患者接受早期AD与无或延迟AD。结果：五年临床失败（从BF日期）是60%的患者经历了前列腺特异性抗原上升到大于或等于3 ng/mL以上的最低点。对于这些患者，早期AD与5年局部失败（4% vs. 33%）、远处转移（13% vs. 44%）、原因特异性死亡（9% vs. 24%）和全因死亡（32% vs. 48%）减少相关，尽管接受早期AD的患者预后因素较差。在多变量分析，早期AD仍然独立显着为每个这些endpoint.Conclusion：AD BF后的疗效取决于BF的定义。当应用最佳BF定义时，早期AD减少远处转移并提高生存率。前列腺特异性抗原升高至高于最低值2 ng/mL或大于或等于3 ng/mL似乎是建立具有临床意义的BF和AD干预时机的最佳选择。(C)2004年爱思唯尔公司
Purpose: We analyzed our experience treating localized prostate cancer to determine the impact of androgen deprivation (AD) on clinical outcome if administered at the time of isolated biochemical failure (BF) vs. after clinical failure (clinical failure), and the associated impact of various BF definitions.Methods: A total of 1,201 patients with stage T1-T3N0M0 prostate cancer were treated with external beam radiotherapy (EBRT) to a median dose of 66.6 Gy. Early AD was defined as administration of AD after BF, without evidence of clinical failure. Delayed AD was defined as administration of AD after clinical failure. Multiple BF definitions were tested for capacity to predict subsequent clinical failure. For each BF definition, outcome was compared for BF patients receiving early AD vs. no or delayed AD.Results: Five-year clinical failure (from date of BF) was 60% for patients who experienced a prostate-specific antigen rise to greater than or equal to3 ng/mL above nadir. For these patients, early AD was associated with decreased 5-year local failure (4% vs. 33%), distant metastasis (13% vs. 44%), cause-specific death (9% vs. 24%), and death due to any cause (32% vs. 48%), despite poorer prognostic factors in patients receiving early AD. On multivariate analysis, early AD remained independently significant for each of these end points.Conclusion: The efficacy of AD after BF varies depending on the BF definition. When an optimal BF definition is applied, early AD decreases distant metastasis and improves survival. Prostate-specific antigen elevation to :2 or greater than or equal to3 ng/mL above nadir seems optimal in establishing clinically significant BF and the timing of AD intervention. (C) 2004 Elsevier Inc.