Time to detectable metastatic disease in patients with rising prostate-specific antigen values following surgery or radiation therapy
Time to detectable metastatic disease in patients with rising prostate-specific antigen values following surgery or radiation therapy
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DOI：
10.1158/1078-0432.ccr-05-1668
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发表时间：
2005-12-15
影响因子：
11.5
通讯作者：
Scher, HI
中科院分区：
文献类型：
--
作者：
Slovin, SF;Wilton, AS;Scher, HI
目的：为了确定与前列腺特异性抗原（PSA）倍增时间< 12个月的手术和/或放射治疗后复发性前列腺癌患者的放射学转移进展的发展相关的因素。148名患者在初次治疗后PSA值升高，PSA倍增时间<按照临床方案入组12个月后，按照方案规定的时间间隔进行随访和监测，包括检查、PSA测定和成像研究（包括计算机断层扫描或磁共振成像和骨扫描），直至检测到转移。使用Kaplan-Meier方法估计无转移生存期，使用比例风险模型估计无进展生存期的预测因素。结果：随访期间，74%（110/148）的患者发生了转移事件。中位无进展生存期为19个月，3年和5年无转移性进展生存期分别为32%和16%。在单因素分析中，诊断时的T分期（P = 0.07）和Gleason分级（P = 0.006）、进入研究方案时的PSA值（P < 0.001）和PSA倍增时间（P < 0.001）与进展相关。这些被组合成一个诺模图，以评估风险为个别patient.Conclusions：肿瘤特征在诊断时，PSA倍增时间复发后，和PSA值的时间的协议是预测转移进展。由于监测时的PSA值具有预测性，因此有利于早期治疗以防止转移性进展。
Purpose: To determine factors associated with the development of radiographic metastatic progression for patients with recurrent prostate cancer following surgery and/or radiation therapy with prostate -specific antigen (PSA) doubling times of < 12 months.Experimental Design: One hundred and forty-eight patients with rising PSA values after primary therapy and a PSA doubling time of < 12 months enrolled on clinical protocols were followed and monitored at protocol-specified intervals with examinations, PSA determinations, and imaging studies that included a computed tomography or magnetic resonance imaging and bone scan until metastases were detected. Metastasis-free survival was estimated using the Kaplan-Meier method and factors predictive of progression-free survival were estimated using the proportional hazards model. A nomogram based on the Cox model was constructed.Results: Metastatic events were documented in 74% (110 of 148) of patients during thefollow-up period. The median progression-free survival was 19 months, with 3- and 5-year metastatic progression -free survival of 32% and 16%, respectively. T stage (P = 0.07) and Gleason grade (P = 0.006) at the time of diagnosis, PSA values at thetime of protocol entry (P < 0.001), and PSA doubling time (P < 0.001) were associated with progression in univariate analysis. These were combined into a nomogram to assess risk for an individual patient.Conclusions: Tumor characteristics at the time of diagnosis, PSA doubling time following relapse, and the PSA value at the time of the protocol are predictive of metastatic progression. Because the PSA value at the time of monitoring was predictive, early treatment to prevent metastatic progression is favored.