Kyeonghyo Lee, Dongchan Kim, J. Nam, D. Park, Wontaek Kim, J. Joo, H. Jeon, Y. Ki, Donghyun Kim
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引用次数: 0
摘要
目的:评估根治性前列腺切除术(RP)后前列腺特异性抗原(PSA)持续存在的情况下,使用雄激素剥夺疗法(ADT)进行挽救性放射治疗(SRT)后疾病进展的风险因素。材料与方法:我们分析了2013年至2019年期间因前列腺癌根治术后PSA持续存在而接受SRT联合ADT治疗的57名患者。终点为疾病进展,定义为生化复发或临床复发。年龄、RP前PSA水平、Gleason评分、病理分期、盆腔淋巴结清扫、手术切缘和RP后6-8周时的PSA作为疾病进展的预测因素进行了分析。数据分析采用 Kaplan-Meier 法和 Cox 回归模型。结果:中位随访时间为 38 个月(四分位数间距为 26-61),17 名患者的病情出现进展。病理 T 分期(pT3b vs. pT3a 或更低;危险比 [HR] = 9.20;p = 0.035)和 RP 后 6-8 周的 PSA 水平(≥2.04 vs. <2.04 ng/mL;HR = 5.85;p = 0.002)是疾病进展的预测因素。pT3b组的5年无疾病进展生存率为46.7%,而pT3a或更低组为92.9%;RP后PSA≥2.04纳克/毫升者为18.4%,而PSA<2.04纳克/毫升者为79.2%。结论病理T分期(pT3b)和RP后PSA≥2.04 ng/mL是RP后PSA持续存在的患者接受ADT SRT治疗后疾病进展的独立风险因素。
Analysis of risk factors for disease progression after salvage radiation therapy with androgen deprivation therapy in prostate cancer patients who have prostate-specific antigen persistence after radical prostatectomy
Purpose: To assess risk factors of disease progression after salvage radiation therapy (SRT) with androgen deprivation therapy (ADT) in case of prostate-specific antigen (PSA) persistence after radical prostatectomy (RP). Materials and Methods: We analyzed 57 patients who received SRT with ADT between 2013 and 2019 due to PSA persistence after RP. The endpoint was disease progression defined by biochemical recurrence or clinical recurrence. Age, Pre-RP PSA level, Gleason score, pathologic stage, presence of pelvic lymph node dissection, surgical margins, and PSA at 6-8 weeks after RP were analyzed as predictive factors for disease progression. Kaplan-Meier method and Cox regression models were used for data analysis. Results: At a median follow-up of 38 months (interquartile range, 26–61), 17 patients had disease progression. Pathologic T stage (pT3b vs. pT3a or lower; hazard ratio [HR] = 9.20; p = 0.035) and PSA level at 6-8 weeks after RP (≥2.04 vs. <2.04 ng/mL; HR = 5.85; p = 0.002) were predictors of disease progression. The 5-year disease progression-free survival rate was 46.7% in pT3b group as compared to 92.9 % in pT3a or lower group, and 18.4% for PSA ≥2.04 ng/mL after RP as compared to 79.2% for PSA <2.04 ng/mL. Conclusion: Pathological T stage (pT3b) and post RP PSA ≥2.04 ng/mL are independent risk factors of disease progression after SRT with ADT in patients with PSA persistence after RP.