Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer: A Multi-institutional Collaboration
Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer: A Multi-institutional Collaboration
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DOI：
10.1016/j.eururo.2011.03.011
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发表时间：
2011-08-01
期刊：
影响因子：
23.4
通讯作者：
Eastham, James A.
中科院分区：
文献类型：
--
作者：
Chade, Daher C.;Shariat, Shahrokh F.;Eastham, James A.
背景资料：肿瘤预后的男性放射复发性前列腺癌（PCa）治疗与挽救根治性前列腺切除术（SRP）定义不清。目的：确定生化复发（BCR），转移，死亡的预测SRP. Design，设置和参与者，以帮助选择患者谁可能受益于SRP.Design，设置和参与者：这是一个回顾性的，国际性的，多机构的队列分析。从1985年到2009年，在三级中心对404名放射复发性前列腺癌患者进行了4.4年的中期随访。干预：开放式SRP。测量：SRP后的BCR定义为血清前列腺特异性抗原（PSA）≥ 0.1或≥ 0.2 ng/ml（取决于机构）。次要终点包括转移进展和癌症特异性死亡。结果和局限性：SRP时的中位年龄为65岁，SRP前的中位PSA为4.5 ng/ml。SRP后，195例患者发生BCR，64例发生转移，40例死于PCa。SRP后10年，无BCR生存率、无转移生存率和癌症特异性生存率（CSS）概率分别为37%（95%置信区间[CI]，31-43）、77%（95% CI，71-82）和83%（95% CI，76-88）。在术前多变量分析中，SRP前PSA和放疗后前列腺活检的Gleason评分预测BCR（p = 0.022;总体p < 0.001）和转移（p = 0.022;总体p < 0.001）。在术后多变量分析中，SRP前PSA和SRP时病理Gleason评分预测BCR（p = 0.014;总体p < 0.001）和转移（p < 0.001;总体p < 0.001）。淋巴结受累（LNI）也可预测转移（p = 0.017）。本研究的主要局限性是其回顾性设计和随访periods.Conclusions：在一个选择组的患者接受SRP的放射复发PCa，从临床转移的自由观察> 75%的患者术后10年。SRP前PSA水平较低和放疗后前列腺活检Gleason评分较低的患者从SRP中治愈的可能性最高。(C)2011年欧洲泌尿外科协会。由Elsevier B出版。V.保留所有权利。
Background: Oncologic outcomes in men with radiation-recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP) are poorly defined.Objective: To identify predictors of biochemical recurrence (BCR), metastasis, and death following SRP to help select patients who may benefit from SRP.Design, setting, and participants: This is a retrospective, international, multi-institutional cohort analysis. There was amedian follow-up of 4.4 yr following SRP performed on 404 men with radiation-recurrent PCa from 1985 to 2009 in tertiary centers.Intervention: Open SRP.Measurements: BCR after SRP was defined as a serum prostate-specific antigen (PSA) >= 0.1 or >= 0.2 ng/ml (depending on the institution). Secondary end points included progression to metastasis and cancerspecific death.Results and limitations: Median age at SRP was 65 yr of age, and median pre-SRP PSA was 4.5 ng/ml. Following SRP, 195 patients experienced BCR, 64 developed metastases, and 40 died from PCa. At 10 yr after SRP, BCR-free survival, metastasis-free survival, and cancer-specific survival (CSS) probabilities were 37% (95% confidence interval [CI], 31-43), 77% (95% CI, 71-82), and 83% (95% CI, 76-88), respectively. On preoperative multivariable analysis, pre-SRP PSA and Gleason score at postradiation prostate biopsy predicted BCR (p = 0.022; global p < 0.001) and metastasis (p = 0.022; global p < 0.001). On postoperative multivariable analysis, pre-SRP PSA and pathologic Gleason score at SRP predicted BCR (p = 0.014; global p < 0.001) and metastasis (p < 0.001; global p < 0.001). Lymph node involvement (LNI) also predicted metastasis (p = 0.017). The main limitations of this study are its retrospective design and the follow-up period.Conclusions: In a select group of patients who underwent SRP for radiation-recurrent PCa, freedom from clinical metastasis was observed in > 75% of patients 10 yr after surgery. Patients with lower pre-SRP PSA levels and lower postradiation prostate biopsy Gleason score have the highest probability of cure from SRP. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.