The Prognostic Impact of Seminal Vesicle Involvement Found at Prostatectomy and the Effects of Adjuvant Radiation: Data From Southwest Oncology Group 8794
The Prognostic Impact of Seminal Vesicle Involvement Found at Prostatectomy and the Effects of Adjuvant Radiation: Data From Southwest Oncology Group 8794
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DOI：
10.1016/j.juro.2008.08.037
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发表时间：
2008-12-01
影响因子：
6.6
通讯作者：
Crawford, E. David
中科院分区：
文献类型：
--
作者：
Swanson, Gregory P.;Goldman, Bryan;Crawford, E. David
目的：从西南肿瘤组的随机研究中，我们评估了精囊受累对预后的影响，以及这些患者是否受益于前列腺切除术后辅助放射治疗。材料和方法：西南肿瘤组研究了8794例随机高危患者（精囊阳性疾病和/或包膜穿透和/或边缘阳性）进行放疗与前列腺切除术后观察。随机选取431例病理晚期前列腺癌患者。结果：中位随访时间为12.2年。139例患者有精囊受累，伴有或不伴有囊膜穿透和/或阳性边缘。与286例精囊阴性疾病患者相比，精囊阳性疾病患者的10年无生化失败生存率（精囊阴性为33%，精囊阳性为22%，p = 0.04）、无转移生存率（分别为70%和56%，p = 0.005）和总生存率（10年总生存率分别为74%和61%，p = 0.02）较差。与观察组相比，接受辅助放疗的精囊阳性疾病患者的10年无生化失败生存率从12%提高到36% (p = 0.001)， 10年总生存率从51%提高到71% (p = 0.08)，无转移生存率从47%提高到66% （p = 0.09）。结论：虽然精囊受累是一个不良预后因素，但长期控制是可能的，特别是如果患者给予辅助放射治疗。这种疗法似乎对精囊受累的患者有效。
Purpose: From the randomized study Southwest Oncology Group 8794 we evaluated the effect of seminal vesicle involvement on outcomes and whether those patients benefited from post-prostatectomy adjuvant radiation therapy.Materials and Methods: Southwest Oncology Group study 8794 randomized high risk patients (with seminal vesicle positive disease and/or capsular penetration and/or positive margins) to radiation vs observation after prostatectomy. A total of 431 subjects with pathologically advanced prostate cancer were randomized.Results: Median followup was 12.2 years. Of the patients 139 had seminal vesicle involvement with or without capsular penetration and/or positive margins. Compared to the 286 patients with seminal vesicle negative disease there was poorer 10-year biochemical failure-free survival (33% for seminal vesicle negative and 22% for seminal vesicle positive, p = 0.04), metastasis-free survival (70% and 56%, respectively, p = 0.005) and overall survival (10-year overall survival 74% and 61%, respectively, p = 0.02) for those with seminal vesicle positive disease. Patients with seminal vesicle positive disease who received adjuvant radiation compared to observation realized an improvement in 10-year biochemical failure-free survival from 12% to 36% (p = 0.001), in 10-year overall survival from 51% to 71% (p = 0.08) and in metastasis-free survival from 47% to 66% (p = 0.09), respectively.Conclusions: Although seminal vesicle involvement is a negative prognostic factor, long-term control is possible especially if patients are given adjuvant radiation therapy. This therapy appears to be effective in patients with seminal vesicle involvement.