PROSTATE-SPECIFIC ANTIGEN FOR PRETREATMENT PREDICTION AND POSTTREATMENT EVALUATION OF OUTCOME AFTER DEFINITIVE IRRADIATION FOR PROSTATE-CANCER
PROSTATE-SPECIFIC ANTIGEN FOR PRETREATMENT PREDICTION AND POSTTREATMENT EVALUATION OF OUTCOME AFTER DEFINITIVE IRRADIATION FOR PROSTATE-CANCER
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DOI：
10.1016/0360-3016(95)00137-n
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发表时间：
1995-05-15
影响因子：
7
通讯作者：
SCHELLHAMMER, PF
中科院分区：
文献类型：
--
作者：
KUBAN, DA;ELMAHDI, AM;SCHELLHAMMER, PF
目的：探讨前列腺癌放疗前前列腺特异性抗原(PSA)的检测对前列腺癌放射治疗后远期疗效的预测价值，并比较手术治疗与放疗后预后因素的分布。方法与材料：1975年至1989年，6 5 2例临床A2-C期前列腺癌患者接受外照射，150例血清PSA水平为治疗前水平，3 5 5例随访17年以上的患者有治疗后价值。治疗失败按肿瘤分期、分级和四个治疗前PSA分类进行分析，疾病进展通过临床和生化(PSA)终点进行评估，预后因素与两个手术系列进行比较。结果：根据肿瘤分级、分期和治疗前PSA分类，临床和PSA无病(PSA小于或等于4.0 ng/ml)状态有显著差异，尽管预期的临床结果以前已有很好的文献记载，但基于治疗后PSA水平的结果显示，根据特定的肿瘤分级和分期，5年无病生存减少10-16%，10年生存减少15-39%。早期、低级别肿瘤在治疗后最长时间内的临床复发率和生化复发率差异最大，更显著的是基于治疗前PSA水平的临床和PSA无病发生率的差异。与两个手术系列比较，前者与前列腺癌切除患者相比，前者更晚期肿瘤的比例更高，PSA水平更差。结论：经过长期随访，治疗前PSA水平仍然是预测明显局限性前列腺癌患者临床和生化结果的有力指标。临床和PSA结果之间的差异可能是相当大的，但通常在临床上并不显著。影响预后的因素在放射治疗和前列腺切除术之间的分布似乎更倾向于后者。
Purpose: This study was undertaken to assess the predictive value of pretreatment prostate-specific: antigen (PSA) and the difference between clinical and PSA disease-free status in patients with long-term follow-up after irradiation for prostatic carcinoma, Comparison of the distribution of prognostic factors between surgical and radiation series was also made,Methods and Materials: From 1975-1989, 652 patients with clinical Stage A2-C prostatic adenocarcinoma were definitively irradiated using external beam therapy, One hundred and fifty patients with banked serum and up to 14 years follow-up have pretreatment PSA levels and 355 patients with up to 17 years follow-up have posttreatment values, Treatment failure was analyzed by tumor stage, grade, and four pretreatment PSA categories, Disease-progression was evaluated by clinical and biochemical (PSA) endpoints, Prognostic factors were compared to two surgical series,Results: A significant difference was seen in clinical and PSA disease-free (PSA less than or equal to 4.0 ng/ml) status based on tumor grade, stage, and pretreatment PSA category, Although the expected clinical outcome has been well-documented previously, results based on posttreatment PSA levels show 5-year disease-free survivals reduced by 10-16% and 10-year survivals lessened by 15-39% depending upon the particular tumor grade and stage, The earlier stage, lower grade tumors showed the largest difference between clinical and biochemical recurrence rates at the longest interval from treatment, Even more notable were tbe differences in the clinical and PSA disease-free rates based on the pretreatment PSA level, Comparing the irradiated patients to two surgical series showed that the former had a larger percentage of more advanced stage tumors with more unfavorable PSA levels as compared to prostatectomy patients,Conclusion: With long-term follow-up, the pretreatment PSA level continues to be a powerful predictor of clinical and biochemical outcome in patients irradiated for apparently localized prostate cancer. Differences between clinical and PSA outcome can be considerable, but oftentimes clinically insignificant. The distribution of prognostic factors between radiation and prostatectomy series seems to favor the latter.