Prostate-Specific Antigen at 4 to 5 Years After Low-Dose-Rate Prostate Brachytherapy Is a Strong Predictor of Disease-Free Survival
Prostate-Specific Antigen at 4 to 5 Years After Low-Dose-Rate Prostate Brachytherapy Is a Strong Predictor of Disease-Free Survival
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DOI：
10.1016/j.ijrobp.2013.10.010
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发表时间：
2014-01-01
影响因子：
7
通讯作者：
Spadinger, Ingrid
中科院分区：
文献类型：
--
作者：
Lo, Andrea C.;Morris, W. James;Spadinger, Ingrid
目的：确定（1）低剂量率前列腺近距离放射治疗（LDR-PB）后45至60个月（48 mPSA）时前列腺特异性抗原（PSA）浓度的预后效用;（2）48 mPSA的预测因子;（3）LDR-PB后24、36和48个月时PSA水平之间的方向趋势的预后效用。方法和材料：在1998年至2008年期间，2223例低危和中危前列腺癌患者接受了LDR-PB单药治疗。这些患者中的1434名患者被确定为具有记录的48 mPSA，并且在48 mPSA之前没有疾病复发的证据。此外，该队列的一个子集（n=585）被确定为随访时间>= 72个月，并在植入后24个月和36个月记录PSA值。对于48 mPSA <0.2 ng/mL的患者，8年Kaplan-Meier无病生存率（DFS）分别为100%和73.4%;对于48 mPSA阈值为0.4 ng/mL的患者，8年DFS分别为99.1%和53.8%;对于阈值为1.0 ng/mL的患者，8年DFS分别为97.3%和0%。在多变量分析中，预测DFS的唯一因素是24至36个月之间的48 mPSA（P0.2 ng/mL），24例患者在36至48个月之间升高，11例患者在两个时间段内均升高。这些患者的失败率分别为52%、79%和100%。在多变量分析中，初始PSA，雄激素剥夺治疗，剂量到90%的前列腺显着相关48 mPSA，但一起只占其总variance.Conclusions：48 mPSA后LDR-PB是高度预测长期DFS。24 - 36个月和36 - 48个月时48 mPSA 0.2 ng/mL的患者也高度预测随后的失败。(C)2014 Elsevier Inc.
Purpose: To determine (1) the prognostic utility of prostate-specific antigen (PSA) concentration at 45 to 60 months (48mPSA) after low-dose-rate prostate brachytherapy (LDR-PB); (2) the predictors of 48mPSA; and (3) the prognostic utility of directional trends between PSA levels at 24, 36, and 48 months after LDR-PB.Methods and Materials: Between 1998 and 2008, 2223 patients with low-and intermediate-risk prostate cancer received LDR-PB monotherapy. A cohort of 1434 of these patients was identified with a documented 48mPSA and no evidence of disease relapse prior to the 48mPSA. In addition, a subset of this cohort (n=585) was identified with >= 72 months of follow-up and documented PSA values at both 24 and 36 months after implantation.Results: Median follow-up time was 76 months. Eight-year Kaplan-Meier disease-free survival (DFS) rates were 100% vs 73.4% for patients with 48mPSA 0.2 ng/mL; 99.1% versus 53.8% for a 48mPSA threshold of 0.4 ng/mL, respectively; and 97.3% versus 0% for a threshold of 1.0 ng/mL, respectively. On multivariate analysis, the only factor predictive of DFS was 48mPSA (P0.2 ng/mL) between 24 and 36 months, 24 patients had a rise between 36 and 48 months, and 11 patients had rises over both intervals. Failure rates in these patients were 52%, 79%, and 100%, respectively. On multivariate analysis, initial PSA, androgen deprivation therapy, and dose to 90% of the prostate significantly correlated with 48mPSA but together accounted for only similar to 5% of its total variance.Conclusions: The 48mPSA after LDR-PB is highly predictive of long-term DFS. Patients with 48mPSA 0.2 ng/mL from 24 to 36 months and from 36 to 48 months were also highly predictive of subsequent failure. (C) 2014 Elsevier Inc.