Is it possible to compare PSA recurrence-free survival after surgery and radiotherapy using revised ASTRO criterion - "Nadir+2"?
Is it possible to compare PSA recurrence-free survival after surgery and radiotherapy using revised ASTRO criterion - "Nadir+2"?
复制标题
DOI：
10.1016/j.urology.2007.10.053
复制
发表时间：
2008-08-01
期刊：
影响因子：
2.1
通讯作者：
Walsh, Patrick C.
中科院分区：
文献类型：
--
作者：
Nielsen, Matthew E.;Makarov, Danil V.;Walsh, Patrick C.
新的美国放射治疗和肿瘤学会/放射治疗肿瘤组对前列腺癌放疗后生化失败的共识定义是前列腺特异性抗原水平等于或大于绝对最低PSA水平加2 ng/mL。Bcccause这个定义不可避免地将被用来比较放疗后的癌症控制率后Surgery，本研究探讨了这种comparison. METHODS的效果，我们回顾了从1985年至2004年接受根治性直肠癌切除术的2570名男性的数据。生化失败定义为任何可测量的PSA水平为0.2 ng/mL或更高。我们评估了最低值+2定义如何影响失败率，当应用于本系列。结果精算5，10和15年生化无复发生存概率与失败定义为PSA水平为0.2 ng/mL或更高和PSA水平为2 ng/mL或更高分别为88.6% 81.2%，78.1%和94.6%，89.4%，84.3%（P < 0.0001）。对于大于0.2 ng/mL的定义，至生化进展的中位时间为2.8年，对于2 ng/mL或更高的定义，为7.9年。最低值+2定义系统性地高估了生化无复发生存率，即使在将患者分为标准预后风险组后，特别是在发生局部复发的男性中。美国放射治疗和肿瘤学会“nadir+2”定义导致生化失败的确定系统性延迟。由于该系列中PSA水平可检测的患者需要5年以上才能进展至PSA水平≥ 2 ng/mL，因此应将定义为≥ 0.2 ng/mL的5年生化控制率与使用最低值+2定义的10年生化控制率进行比较。
OBJECTIVES The new American Society for Therapeutic Radiology and Oncology/Radiation Therapy Oncology Group consensus definition of biochemical failure after radiotherapy for prostate cancer is defined as a prostate-specific antigen level at or greater than the absolute nadir PSA level plus 2 ng/mL. Bccause this definition inevitably will be used to compare cancer control rates after radiotherapy to those after Surgery, this study examined the effect of this comparison.METHODS We reviewed the data from 2570 men who had undergone radical prostatectomy from 1985 to 2004. Biochemical failure was defined as any measurable PSA level Of 0.2 ng/mL or greater. We evaluated how the nadir+2 definition affected the failure rate when applied to this series.RESULTS The actuarial 5, 10, and 15-year biochemical recurrence-free survival probability with failure defined as a PSA level of 0.2 ng/mL or more and a PSA level of 2 ng/mL or more was 88.6% 81.2%, and 78.1% and 94.6%, 89.4%, and 84.3%), respectively (P < 0.0001). The median time to biochemical progression was 2.8 years for the greater than 0.2 ng/mL definition and 7.9 years for the 2 ng/mL or more definition. The nadir+2 definition systematically overestimated the biochemical recurrence-free survival, even after stratifying patients into standard prognostic risk groups, especially in men who developed local recurrence.CONCLUSIONS When applied to a mature series of surgically treated patients with localized prostate cancer, the American Society for Therapeutic Radiology and Oncology "nadir+2" definition resulted in a systematic delay in the determination of biochemical failure. Because patients in this series who experienced a detectable PSA level took more than 5 years to progress to a PSA level of 2 ng/mL or greater, the 5-year biochemical control rates with the definition of 0.2 ng/mL or more should be compared with the 10-year biochemical control rates using the nadir+2 definition.