Prognostic significance of perineural invasion on biochemical progress ion-free survival after prostate brachytherapy
Prognostic significance of perineural invasion on biochemical progress ion-free survival after prostate brachytherapy
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DOI：
10.1016/j.urology.2005.05.024
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发表时间：
2005-11-01
期刊：
影响因子：
2.1
通讯作者：
Adamovich, E
中科院分区：
文献类型：
--
作者：
Merrick, GS;Butler, WM;Adamovich, E
目标.评估活检标本中神经周围浸润（PNI）对接受近距离放射治疗的前列腺癌初治患者生化无进展生存期的影响。共有512名连续的未经放疗的患者（173名低风险，212名中等风险和127名高风险）因临床分期T1 b-T2 cNxM 0（2002年美国癌症联合委员会分期系统）前列腺癌接受了近距离放射治疗。没有患者接受精囊或病理淋巴结分期。所有患者在分析前至少3年接受了近距离放射治疗。中位随访时间为5.3年。生化无进展生存期的定义为前列腺特异性抗原（PSA）临界点在最低点后≤ 0.4 ng/mL，以及美国放射治疗和肿瘤学会共识定义。PNI定义为肿瘤沿着神经或神经周围浸润。133例（26.0%）患者记录到PNI。对于两种生化无进展定义，分别有94.0%和94.9%的PNI患者保持无生化进展。有和无PNI患者的中位失败时间分别为17.2和17.9个月。对于生化无疾病队列，中位治疗后PSA水平低于0.1 ng/mL。在单变量考克斯回归分析中，治疗前PSA水平、阳性活检百分比、前列腺体积和Gleason评分可预测生化结局。PNI无统计学意义（P = 0.671）。多因素分析中，只有治疗前PSA（P < 0.001）和活检阳性率（P < 0.001）仍有统计学意义。在植入了大量前列腺周围治疗切缘的未接受过近距离放射治疗的患者中，活检标本中PNI的存在对8年生化无进展生存率没有不利影响。
Objectives. To evaluate the influence of perineural invasion (PNI) in the biopsy specimen on biochemical progression-free survival in hormone-naive patients with prostate cancer undergoing brachytherapy.Methods. A total of 512 consecutive hormone-naive patients (173 low risk, 212 intermediate risk, and 127 high risk) underwent brachytherapy for clinical Stage T1b-T2cNxM0 (2002 American Joint Committee on Cancer staging system) prostate cancer. No patient underwent seminal vesicle or pathologic lymph node staging. All patients had undergone brachytherapy at least 3 years before analysis. The median follow-up was 5.3 years. Biochemical progression-free survival was defined by a prostate-specific antigen (PSA) cutpoint of 0.4 ng/mL or less after nadir and by the American Society for Therapeutic Radiology and Oncology consensus definition. PNI was defined as carcinoma tracking along, or around, a nerve within the perineural space.Results. PNI was documented in 133 patients (26.0%). For both biochemical progression-free definitions, 94.0% and 94.9% of patients with and without PNI, respectively, remained free of biochemical progression. The median time to failure in patients with and without PNI was 17.2 and 17.9 months, respectively. For the biochemically disease-free cohort, the median posttreatment PSA level was less than 0.1 ng/mL. On univariate Cox regression analysis, the pretreatment PSA level, percentage of positive biopsies, prostate volume, and Gleason score predicted for biochemical outcome. PNI did not approach statistical significance (P = 0.671). On multivariate analysis, only pretreatment PSA (P < 0.001) and the percentage of positive biopsies (P < 0.001) maintained statistical significance.Conclusions. In hormone-naive brachytherapy patients implanted with generous periprostatic treatment margins, the presence of PNI in the biopsy specimen did not adversely affect 8-year biochemical progression-free survival.