Detectable end of radiation prostate specific antigen assists in identifying men with unfavorable intermediate-risk prostate cancer at high risk of distant recurrence and cancer-specific mortality.
Detectable end of radiation prostate specific antigen assists in identifying men with unfavorable intermediate-risk prostate cancer at high risk of distant recurrence and cancer-specific mortality.
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可检测的放射终点前列腺特异性抗原有助于识别患有不利的中危前列腺癌的男性，这些男性具有远处复发和癌症特异性死亡率的高风险。
DOI：
10.1002/pros.23507
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Tran,PhuocT
中科院分区：
文献类型：
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作者：
Hayman,Jonathan;Phillips,Ryan;Chen,Di;Perin,Jamie;Narang,AmolK;Trieu,Janson;Radwan,Noura;Greco,Stephen;DevilleJr,Curtiland;McNutt,Todd;Song,DanielY;DeWeese,TheodoreL;Tran,PhuocT
背景不可检测的放射结束PSA（EOR‐PSA）已被证明可预测前列腺癌（PCa）生存率的改善。虽然验证不利的中间风险（UIR）和有利的中间风险（FIR）的约翰霍普金斯大学前列腺癌患者接受放疗的分层，我们研究是否EOR-PSA可以进一步的风险分层UIR男性survival.MethodsA共302 IR患者中确定的约翰霍普金斯大学前列腺癌数据库（178 UIR，124 FIR）。通过考克斯回归对生化无复发生存期（bRFS）、无远处转移生存期（DMFS）和总生存期（OS）进行Kaplan-Meier曲线和多变量分析，而竞争风险模型用于PCa特异性生存期（PCSS）。在235例已知EOR‐PSA值的患者中，我们随后按EOR‐PSA进行分层并进行上述分析。多变量分析（MVA）显示UIR可预测DMFS和PCSS恶化（P= 0.008和P = 0.023）。增加辐射剂量对MVA的DMFS改善有显著意义（P= 0.016）。从模型中排除EOR‐PSA，因为由于与UIR的相互作用，其作为连续或二元变量没有显著性趋势，并且我们无法收敛多变量模型，其中变量用于控制这种相互作用。然而，当按可检测与不可检测的EOR‐PSA分层时，UIR在可检测的EOR‐PSA患者中的DMFS和PCSS更差，但在不可检测的患者中并非如此。UIR在可检测EOR-PSA患者的MVA中对DMFS（P= 0.021）和PCSS（P= 0.033）具有显著性，而RT剂量也可预测PCSS（P= 0.013）。结论EOR-PSA可帮助预测UIR患者的DMFS和PCSS，提示在中等风险男性的临床试验中考虑强化治疗的临床有意义的时间点。
BackgroundUndetectable End of Radiation PSA (EOR‐PSA) has been shown to predict improved survival in prostate cancer (PCa). While validating the unfavorable intermediate‐risk (UIR) and favorable intermediate‐risk (FIR) stratifications among Johns Hopkins PCa patients treated with radiotherapy, we examined whether EOR‐PSA could further risk stratify UIR men for survival.MethodsA total of 302 IR patients were identified in the Johns Hopkins PCa database (178 UIR, 124 FIR). Kaplan‐Meier curves and multivariable analysis was performed via Cox regression for biochemical recurrence free survival (bRFS), distant metastasis free survival (DMFS), and overall survival (OS), while a competing risks model was used for PCa specific survival (PCSS). Among the 235 patients with known EOR‐PSA values, we then stratified by EOR‐PSA and performed the aforementioned analysis.ResultsThe median follow‐up time was 11.5 years (138 months). UIR was predictive of worse DMFS and PCSS (P= 0.008 andP= 0.023) on multivariable analysis (MVA). Increased radiation dose was significant for improved DMFS (P= 0.016) on MVA. EOR‐PSA was excluded from the models because it did not trend towards significance as a continuous or binary variable due to interaction with UIR, and we were unable to converge a multivariable model with a variable to control for this interaction. However, when stratifying by detectable versus undetectable EOR‐PSA, UIR had worse DMFS and PCSS among detectable EOR‐PSA patients, but not undetectable patients. UIR was significant on MVA among detectable EOR‐PSA patients for DMFS (P= 0.021) and PCSS (P= 0.033), while RT dose also predicted PCSS (P= 0.013).ConclusionsEOR‐PSA can assist in predicting DMFS and PCSS among UIR patients, suggesting a clinically meaningful time point for considering intensification of treatment in clinical trials of intermediate‐risk men.