Comparison of biochemical failure definitions for permanent prostate brachytherapy
Comparison of biochemical failure definitions for permanent prostate brachytherapy
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DOI：
10.1016/j.ijrobp.2006.03.027
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发表时间：
2006-08-01
影响因子：
7
通讯作者：
Horwitz, Eric M.
中科院分区：
文献类型：
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作者：
Kuban, Deborah A.;Levy, Larry B.;Horwitz, Eric M.
目的：探讨前列腺特异性抗原(PSA)在T1-T2期前列腺癌永久性近距离放射治疗中的失效定义。方法与材料：对2,693例T1-T2期前列腺癌患者进行放射性同位素植入治疗。所有患者都接受了PSA治疗，分析前至少5年(1988年至1998年)接受过治疗，在复发前没有接受激素治疗。对多种PSA失败定义预测临床失败的能力进行了检验。结果：以PSA升高一定幅度超过最低PSA水平(nadir+x ng/m L)来确定失败的定义比基于PSA倍增时间或PSA上升一定次数的失败定义更敏感、更具体。NADIR+2定义的敏感度和特异度分别为72%和83%，而PSA升高3次的敏感度和特异度分别为51%和81%。手术类型定义(PSA超过绝对值)可以匹配这种敏感度和特异度，但只有当失败被定义为超过1-3 ng/ml范围的PSA时，并且只有当患者被允许有足够的时间达到最低点时。结论：对于接受永久性放射性同位素植入术的前列腺癌患者，在整个随访期内，NEIR+2 ng/mL的定义是失败的最佳替代物，与外照射治疗的患者相似。因此，两种医疗设备可以使用相同的PSA故障定义。对于长期随访至少6年的近距离放射治疗患者，将失败定义为超过0.5 ng/ml范围内的PSA绝对值可能是合理的。(C)2006年爱思唯尔公司。
Purpose: To assess prostate-specific antigen (PSA) failure definitions for patients with Stage T1-T2 prostate cancer treated by permanent prostate brachytherapy.Methods and Materials: A total of 2,693 patients treated with radioisotopic implant as solitary treatment for T1-T2 prostatic adenocarcinoma were studied. All patients had a pretreatment PSA, were treated at least 5 years before analysis, 1988 to 1998, and did not receive hormonal therapy before recurrence. Multiple PSA failure definitions were tested for their ability to predict clinical failure.Results: Definitions which determined failure by a certain increment of PSA rise above the lowest PSA level to date (nadir + x ng/mL) were more sensitive and specific than failure definitions based on PSA doubling time or a certain number of PSA rises. The sensitivity and specificity for the nadir + 2 definition were 72% and 83%, vs. 51% and 81% for 3 PSA rises. The surgical type definitions (PSA exceeding an absolute value) could match this sensitivity and specificity but only when failure was defined as exceeding a PSA level in the 1-3 ng/mL range and only when patients were allowed adequate time to nadir. When failure definitions were compared by time varying covariate regression analysis, nadir + 2 ng/mL retained the best fit.Conclusions: For patients treated by permanent radioisotopic implant for prostate cancer, the definition nadir + 2 ng/mL provides the best surrogate for failure throughout the entire follow-up period, similar to patients treated by external beam radiotherapy. Therefore, the same PSA failure definition could be used for both modalities. For brachytherapy patients with long-term follow-up, at least 6 years, defining failure as exceeding an absolute PSA level in the 0.5 ng/mL range may be reasonable. (c) 2006 Elsevier Inc.