Determinants of prostate cancer specific survival following radiation therapy during the prostate specific antigen era
Determinants of prostate cancer specific survival following radiation therapy during the prostate specific antigen era
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DOI：
10.1097/01.ju.0000094800.63501.15
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发表时间：
2003-12-01
影响因子：
6.6
通讯作者：
Schultz, D
中科院分区：
文献类型：
--
作者：
D'Amico, AV;Cote, K;Schultz, D
目的：识别治疗前和治疗后预测前列腺癌特异性死亡（PCSD）的时间外照射放射治疗（RT）是本study.Materials和Methods的主题：一个考克斯回归分析被用来评估的能力的预处理风险组预测PCSD的时间为381例接受RT临床局限性前列腺癌。对94例前列腺特异性抗原（PSA）治疗失败的患者分析的治疗后因素包括失败时间、治疗后PSA倍增时间（DT）和补救性激素治疗的时间。尽管确诊时的中位年龄为73岁，据估计，45%的高危疾病患者在放疗后10年内死于前列腺癌，而0%的患者在放疗后10年内死于前列腺癌。（p=0.004）和6%（p=0.05）的低或中等风险疾病。PSA失败后PCSD时间的预测因素包括PSA DT（p=0.01）和激素治疗延迟（小于或等于0.002）。几乎相同的估计PCSD和全因死亡后PSA失败的患者指出，短PSA DT（即12个月或更少）。结论：前列腺癌是一个主要的死亡原因，在第一个十年后RT的患者与临床局部，但高风险的疾病，和死亡的原因，短PSA DT后RT的患者几乎总是前列腺癌。这些数据提供了证据，提出了一个假设，即短期治疗后PSA DT可能作为PCSD的替代。需要前瞻性验证。
Purpose: Identifying pretreatment and posttreatment predictors of time to prostate cancer specific death (PCSD) following external beam radiation therapy (RT) is the subject of this study.Materials and Methods: A Cox regression analysis was used to evaluate the ability of the pretreatment risk group to predict time to PCSD for 381 patients who underwent RT for clinically localized prostate cancer. Posttreatment factors analyzed for the 94 patients who experienced prostate specific antigen (PSA) failure included the time to failure, posttreatment PSA doubling time (DT) and timing of salvage hormonal therapy.Results: Despite a median age of 73 at diagnosis, 45% of patients with high risk disease were estimated to die of prostate cancer within 10 years following RT compared to 0% (p=0.004) and 6% (p=0.05) of those with low or intermediate risk disease, respectively. Predictors of time to PCSD following PSA failure included PSA DT (p=0.01) and delayed use of hormonal therapy (pless than or equal to0.002). Nearly identical estimates of PCSD and all cause death following PSA failure were noted for patients with a short PSA DT (ie 12 months or less).Conclusions: Prostate cancer was a major cause of death during the first decade following RT for patients with clinically localized but high risk disease, and the cause of death for patients with a short PSA DT following RT was nearly always prostate cancer. These data provide evidence to propose the hypothesis that a short posttreatment PSA DT may serve as a possible surrogate for PCSD. Prospective validation is needed.