GLEASON PATTERN 5 IS THE GREATEST RISK FACTOR FOR CLINICAL FAILURE AND DEATH FROM PROSTATE CANCER AFTER DOSE-ESCALATED RADIATION THERAPY AND HORMONAL ABLATION
GLEASON PATTERN 5 IS THE GREATEST RISK FACTOR FOR CLINICAL FAILURE AND DEATH FROM PROSTATE CANCER AFTER DOSE-ESCALATED RADIATION THERAPY AND HORMONAL ABLATION
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DOI：
10.1016/j.ijrobp.2011.01.063
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发表时间：
2011-11-15
影响因子：
7
通讯作者：
Hamstra, Daniel A.
中科院分区：
文献类型：
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作者：
Sabolch, Aaron;Feng, Felix Y.;Hamstra, Daniel A.
目的：Gleason评分(GS)分为2-6、7、8-10三种类型可能不能充分发挥其预后作用，最近的报道显示Gleason Pattern5(GP5)是生化复发的有力预测因子。因此，我们分析了基于GP5存在或不存在而接受剂量递增放射治疗(RT)的患者的临床结果。方法和材料：对718名接受外照射治疗的局限性前列腺癌患者的结果进行了分析，最低计划目标体积剂量至少为75Gy.我们评估了GP5以及治疗前和治疗相关因素对免于生化失败、免于转移(FFM)、病因特异性生存(CSS)和总生存(OS)的影响。结果：在活检时，89%的患者没有GP5，11%(76/718)有GP5。没有GP5的GS8和有GP5的GS8-10在年龄、合并症、T分期、前列腺特异性抗原、雄激素剥夺治疗的使用或持续时间方面没有差异。与没有GP5的GS8相比，GP5的存在预示着较低的FFM(p<；0.002；危险比[HR]3.41.7-7.1.)；css(p<；0.0001；HR12.9[5.4-31])和OS(p<；0.0001；HR3.6[2.06.5])。没有GP5的Gleason 8前列腺癌患者的8年FFM、CS和OS分别为89%、98%和57%，而GP5患者分别为61%、55%和31%。此外，雄激素剥夺治疗与RT同时进行，对FFM和CS都有很大影响。在多变量分析中，GP5是包括OS在内的所有临床终点的最强预后因素。结论：GP5的存在预示着更糟糕的临床行为，因此需要通过风险分层方案加以考虑。对于此类患者，进一步加强局部和/或系统治疗可能是合适的。(C)2011年爱思唯尔公司。
Purpose: The division of Gleason score (GS) into three categories (2-6, 7, 8-10) may not fully use its prognostic power, as revealed by recent reports demonstrating the presence of Gleason Pattern 5 (GP5) as a strong predictor for biochemical recurrence. Therefore, we analyzed the clinical outcomes in patients treated with dose-escalated radiation therapy (RT) based on the presence or absence of GP5.Methods and Materials: Outcomes were analyzed for 718 men treated for localized prostate cancer with external-beam RT to a minimum planning target volume dose of at least 75 Gy. We assessed the impact of GP5 and that of pretreatment-and treatment-related factors on freedom from biochemical failure, freedom from metastasis (FFM), cause-specific survival (CSS), and overall survival (OS).Results: At biopsy, 89% of patients had no GP5, and 11% (76/718) had GP5. There were no differences in age, comorbid illness, T stage, prostate-specific antigen, or the use or duration of androgen deprivation therapy between GS8 without GP5 and GS8-10 with GP5. The presence of GP5 predicted lower FFM (p < 0.002; hazard ratio [HR] 3.4 [1.7-7.1]); CSS (p < 0.0001; HR 12.9 [5.4-31]); and OS (p < 0.0001; HR 3.6 [2.0-6.5]) in comparison with GS8 (without GP5). The 8-year FFM, CSS, and OS were 89%, 98%, and 57%, respectively, for those with Gleason 8 prostate cancer without GP5 in comparison with 61%, 55%, and 31%, respectively, for those with GP5. In addition, both FFM and CSS were strongly influenced by androgen deprivation therapy given concurrently with RT. On multivariate analysis, GP5 was the strongest prognostic factor for all clinical endpoints, including OS.Conclusion: The presence of GP5 predicts for worse clinical behavior, which therefore needs to be accounted for by risk stratification schemes. Further intensification of local and/or systemic therapy may be appropriate for such patients. (C) 2011 Elsevier Inc.