Time to prostate specific antigen recurrence after radical prostatectomy and risk of prostate cancer specific mortality
Time to prostate specific antigen recurrence after radical prostatectomy and risk of prostate cancer specific mortality
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DOI：
10.1016/j.juro.2006.06.017
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发表时间：
2006-10-01
影响因子：
6.6
通讯作者：
Partin, Alan W.
中科院分区：
文献类型：
--
作者：
Freedland, Stephen J.;Humphreys, Elizabeth B.;Partin, Alan W.
目的：在接受根治性前列腺切除术治疗的生化复发患者中，我们以前曾报道，从手术到生化复发的时间和术后前列腺特异性抗原倍增时间与前列腺癌死亡风险显著相关。我们进行了一个更彻底的检查，从手术到生化复发和前列腺癌death.Materials和方法的风险的关联时间：我们回顾性研究了1982年和2000年之间的379例根治性前列腺切除术治疗的生化复发的记录。我们分别使用斯皮尔曼相关性和考克斯比例风险回归来检查从手术到前列腺特异性抗原复发的时间和前列腺特异性抗原倍增时间与前列腺癌死亡风险的关系。结果：从手术到前列腺特异性抗原复发的时间越长，前列腺特异性抗原倍增时间越慢（斯皮尔曼r = 0.36，p < 0.001）和前列腺癌死亡风险降低（RR 0.76，95% CI 0.66 - 0.88，p < 0.001）。在根治性前列腺切除术后3年或3年以下复发的患者中，生化复发后15年的前列腺癌特异性生存率为41%（95% CI 29至53），而在根治性前列腺切除术后3年以上复发的患者中，15年的确切前列腺癌特异性生存率为87%（95% CI 75至93）。在多变量分析中，从手术到前列腺特异性抗原复发的时间较短与前列腺癌死亡风险增加相关（3年或3年以下vs 3年以上，RR 2.70，95%CI 1.37至5.31，p = 0.004）。这些数据表明，前列腺特异性抗原复发的时间可能是接受根治性前列腺切除术的患者的合理中间终点，尽管这必须在其他研究中得到验证。
Purpose: In patients treated with radical prostatectomy who have biochemical recurrence we have previously reported that time from surgery to biochemical recurrence and postoperative prostate specific antigen doubling time are significantly related to the risk of prostate cancer death. We performed a more thorough examination of the association of time from surgery to biochemical recurrence and the risk of prostate cancer death.Materials and Methods: We retrospectively studied the records of 379 patients treated with radical prostatectomy between 1982 and 2000 who had had biochemical recurrence. We examined the association of time from surgery to prostate specific antigen recurrence and prostate specific antigen doubling time, and the risk of prostate cancer death using the Spearman correlation and Cox proportional hazards regression, respectively.Results: Longer time from surgery to prostate specific antigen recurrence was associated with a slower prostate specific antigen doubling time (Spearman r = 0.36, p < 0.001) and a decreased risk of prostate cancer death (RR 0.76, 95% CI 0.66 to 0.88, p < 0.001). The 15-year actuarial prostate cancer specific survival rate after biochemical recurrence in patients with recurrence at 3 years or less was 41% (95% CI 29 to 53) compared to 87% (95% CI 75 to 93) in patients with recurrence more than 3 years after radical prostatectomy. On multivariate analysis a shorter time from surgery to prostate specific antigen recurrence was associated with an increased risk of prostate cancer death (3 or less vs more than 3 years, RR 2.70, 95% CI 1.37 to 5.31, p = 0.004).Conclusions: Earlier prostate specific antigen recurrence is associated with an increased risk of prostate cancer death. These data suggest that perhaps time to prostate specific antigen recurrence may be a reasonable intermediate end point in patients treated with radical prostatectomy, although this must be validated in other studies.