Abstract：
OBJECTIVE: Salvage radiotherapy (SRT) is a curative treatment option in patients with biochemical recurrence after radical prostatectomy (RP). Undetectable prostate-specific antigen (PSA) < 0.1 ng/mL following SRT predicts biochemical progression-free survival (BPFS). The aim of this large retrospective study was to evaluate whether this effect persists in an extended follow-up of >5 years.
METHODS: A total of 678 patients treated with SRT for biochemical recurrence after RP were included. Exclusion criteria were lymph node or distant metastases, pre-SRT PSA > 3 ng/mL, and receipt of androgen deprivation therapy (ADT) between RP and SRT. All patients received a median dose of 70.2 (range 59.4-72.0) Gy to the prostatic fossa. The log-rank test (Kaplan-Meier) and Cox regression analysis were used to evaluate the impact of disease- and treatment-related parameters on BPFS, metastasis-free survival (MFS), and overall survival (OS).
RESULTS: Median follow-up after SRT was 5.6 (range 0.1-14.5) years. The 5-year BPFS was 77.8 % in patients with a PSA nadir < 0.1 ng/mL (undetectable) and 16.3 % in the remaining cohort (p < 0.001). Five-year MFS was 95.3 % with undetectable PSA versus 84.0 % with detectable PSA (p < 0.001), and 5-year OS values were 97.5 % and 92.7 % with undetectable versus detectable PSA, respectively (p = 0.04). In multivariate analysis, undetectable PSA was the strongest predictor of BPFS (HR = 0.122; 95 %CI: 0.080-0.187; p < 0.001) and MFS (HR = 0.262; 95 %CI: 0.136-0.594; p < 0.001), but was not significant for OS (HR = 0.615; 95 %CI: 0.298-1.269; p = 0.189).
CONCLUSIONS: PSA < 0.1 ng/mL following SRT without ADT is a significant predictor of BPFS and MFS. The results suggest that it might be feasible to withhold ADT in selected patients if they have undetectable PSA after SRT. Prospective studies are warranted to confirm these findings.
METHODS: A total of 678 patients treated with SRT for biochemical recurrence after RP were included. Exclusion criteria were lymph node or distant metastases, pre-SRT PSA > 3 ng/mL, and receipt of androgen deprivation therapy (ADT) between RP and SRT. All patients received a median dose of 70.2 (range 59.4-72.0) Gy to the prostatic fossa. The log-rank test (Kaplan-Meier) and Cox regression analysis were used to evaluate the impact of disease- and treatment-related parameters on BPFS, metastasis-free survival (MFS), and overall survival (OS).
RESULTS: Median follow-up after SRT was 5.6 (range 0.1-14.5) years. The 5-year BPFS was 77.8 % in patients with a PSA nadir < 0.1 ng/mL (undetectable) and 16.3 % in the remaining cohort (p < 0.001). Five-year MFS was 95.3 % with undetectable PSA versus 84.0 % with detectable PSA (p < 0.001), and 5-year OS values were 97.5 % and 92.7 % with undetectable versus detectable PSA, respectively (p = 0.04). In multivariate analysis, undetectable PSA was the strongest predictor of BPFS (HR = 0.122; 95 %CI: 0.080-0.187; p < 0.001) and MFS (HR = 0.262; 95 %CI: 0.136-0.594; p < 0.001), but was not significant for OS (HR = 0.615; 95 %CI: 0.298-1.269; p = 0.189).
CONCLUSIONS: PSA < 0.1 ng/mL following SRT without ADT is a significant predictor of BPFS and MFS. The results suggest that it might be feasible to withhold ADT in selected patients if they have undetectable PSA after SRT. Prospective studies are warranted to confirm these findings.
摘要：
目的：挽救性放疗（SRT）是根治性前列腺切除术（RP）后生化复发患者的一种治疗选择。SRT后检测不到的前列腺特异性抗原（PSA）<0.1ng/mL可预测生化无进展生存期（BPFS）。这项大型回顾性研究的目的是评估这种效应是否持续超过5年的长期随访。
方法：共678例因RP后生化复发而接受SRT治疗的患者。排除标准为淋巴结或远处转移，SRT前PSA>3ng/mL，RP和SRT之间接受雄激素剥夺治疗（ADT）。所有患者接受前列腺窝的中位剂量为70.2（范围59.4-72.0）Gy。使用对数秩检验（Kaplan-Meier）和Cox回归分析评估疾病和治疗相关参数对BPFS的影响。无转移生存率（MFS），总生存率（OS）。
结果：SRT后的中位随访时间为5.6（范围0.1-14.5）年。PSA最低点<0.1ng/mL（检测不到）的患者的5年BPFS为77.8％，其余队列为16.3％（p<0.001）。五年MFS为95.3%，PSA检测不到，PSA检测为84.0%(p<0.001)，5年OS值分别为97.5%和92.7%，PSA检测不到，分别(p=0.04)。在多变量分析中，无法检测的PSA是BPFS（HR=0.122;95CI：0.080-0.187;p<0.001）和MFS（HR=0.262;95CI：0.136-0.594;p<0.001）的最强预测因子，但对OS不显著(HR=0.615;95CI:0.298-1.269;p=0.189)。
结论：无ADT的SRT后PSA<0.1ng/mL是BPFS和MFS的重要预测因子。结果表明，如果选定的患者在SRT后无法检测到PSA，则保留ADT可能是可行的。有必要进行前瞻性研究以证实这些发现。
方法：共678例因RP后生化复发而接受SRT治疗的患者。排除标准为淋巴结或远处转移，SRT前PSA>3ng/mL，RP和SRT之间接受雄激素剥夺治疗（ADT）。所有患者接受前列腺窝的中位剂量为70.2（范围59.4-72.0）Gy。使用对数秩检验（Kaplan-Meier）和Cox回归分析评估疾病和治疗相关参数对BPFS的影响。无转移生存率（MFS），总生存率（OS）。
结果：SRT后的中位随访时间为5.6（范围0.1-14.5）年。PSA最低点<0.1ng/mL（检测不到）的患者的5年BPFS为77.8％，其余队列为16.3％（p<0.001）。五年MFS为95.3%，PSA检测不到，PSA检测为84.0%(p<0.001)，5年OS值分别为97.5%和92.7%，PSA检测不到，分别(p=0.04)。在多变量分析中，无法检测的PSA是BPFS（HR=0.122;95CI：0.080-0.187;p<0.001）和MFS（HR=0.262;95CI：0.136-0.594;p<0.001）的最强预测因子，但对OS不显著(HR=0.615;95CI:0.298-1.269;p=0.189)。
结论：无ADT的SRT后PSA<0.1ng/mL是BPFS和MFS的重要预测因子。结果表明，如果选定的患者在SRT后无法检测到PSA，则保留ADT可能是可行的。有必要进行前瞻性研究以证实这些发现。
