Risk of prostate cancer recurrence in men treated with radiation alone or in conjunction with combined or less than combined androgen suppression therapy
Risk of prostate cancer recurrence in men treated with radiation alone or in conjunction with combined or less than combined androgen suppression therapy
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DOI：
10.1200/jco.2007.15.9699
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发表时间：
2008-06-20
影响因子：
45.3
通讯作者：
Kantoff, Philip W.
中科院分区：
文献类型：
--
作者：
D'Amico, Anthony V.;Chen, Ming-Hui;Kantoff, Philip W.
研究目的：我们确定了参加一项随机试验的前列腺癌患者的复发风险，这些患者接受了单独的放射治疗（RT）或联合或少于联合的雄激素抑制治疗（AST）。患者和方法：在1995年至2001年期间，206名患有局限性但不可切除风险的前列腺癌的男性被随机分配接受RT或RT和AST，其被定义为6个月的促黄体生成激素释放激素激动剂和抗雄激素。采用多变量考克斯回归分析产生的随机分配后假设来评估前列腺特异性抗原（PSA）复发风险是否与抗雄激素治疗月数显著相关;回归分析校正了已知的预后因素，合并症评分，和药物，可以提高肝功能测试足以有必要停止抗雄激素。8.2年（四分位距，7.0至9.5年），81名男性持续PSA复发。PSA水平升高（P <0.001）; Gleason评分为8、9或10（P <0.001）;临床分类为T2疾病（P = 0.005）与复发风险增加显著相关。然而，复发风险显著降低（校正后的风险比，0.81; 95% CI，0.72至0.92; P = 0.001）与抗雄激素使用后的每一个额外的月分析调整这些已知的预后因素。接受RT和6个月计划联合AST治疗的风险前列腺癌患者，与6个月计划联合AST治疗相比，抗雄激素
PurposeWe determined the risk of recurrence in men enrolled on a randomized trial for prostate cancer who were treated with radiation therapy (RT) alone or in conjunction with combined or less than combined androgen suppression therapy (AST).Patients and MethodsBetween 1995 and 2001, 206 men with localized but unfavorable-risk adenocarcinoma of the prostate were randomly assigned to receive RT or RT and AST, which was defined as 6 months of both a luteinizing hormone-releasing hormone agonist and an antiandrogen. A post -random assignment hypothesis that was generated by multivariable Cox regression analyses was used to evaluate whether the risk of prostate-specific antigen (PSA) recurrence was significantly associated with months of antiandrogen use; regression analysis adjusted for known prognostic factors, comorbidity score, and medications that can elevate liver function tests sufficiently to necessitate discontinuation of the antiandrogen.ResultsAfter a median follow-up of 8.2 years (interquartile range, 7.0 to 9.5 years), 81 men sustained PSA recurrence. An increasing PSA level (P < .001); Gleason score of 8, 9, or 10 (P < .001); and clinical category T2 disease (P = .005) were significantly associated with an increased risk of recurrence. However, recurrence risk was significantly decreased (adjusted hazard ratio, 0.81; 95% CI, 0.72 to 0.92; P = .001) with each additional month of antiandrogen use after analysis was adjusted for these known prognostic factors.ConclusionMen with localized but unfavorable-risk prostate cancer who were treated with RT and 6 months of planned combined AST appear to have an increased risk of recurrence when treated with less than as compared with 6 months of the antiandrogen.