调强放疗联合新辅助内分泌方法治疗局限期前列腺癌的生存分析

目的 回顾性分析调强放疗联合新辅助内分泌方法治疗局限期前列腺癌的结果并研究影响总生存率的因素.方法 以2003-2008年间54例接受调强放疗的局限期前列腺癌为研究对象,所有病例均在放疗前接受内分泌治疗.内分泌治疗包括药物去势和手术去势联合雄激素拮抗剂,调强放疗范围为前列腺区加或不加盆腔照射.内分泌治疗生化失败采用Phoenix定义法.采用D'Amico等提出的危险度分组标准分为低危组5例,中危组12例,高危组37例.采用Kaplan-Meier法计算总生存率,单因素分析和Cox回归模型来研究与总生存相关因素.结果 随访率为98%,随访满3、5年者分别为39、25例.对危险度分组、内分泌治疗方式、内分泌治疗时间、放疗前phoenix分组、放疗前前列腺特异抗原(PSA)倍增时间、放疗前PSA值、放疗开始时间间隔、照射范围、照射剂量的单因素分析结果显示内分泌治疗时间、放疗前phoenix分组、放疗开始时间间隔、照射剂量与3年总生存率显著相关,分别为75%:95%(χ~2=6.45,P=0.011)、87%:96%(χ~2=4.36,P=0.037)、80%:95%(χ~2=11.60,P=0.001)、75%:91%(χ~2=5.92,P=0.015);危险度分组、放疗前PSA倍增时间与中位总生存期(月)显著相关,分别为85:53:29(χ~2=6.40,P=0.041)、62:120(U=24.50,P=0.003).Cox多因素分析显示内分泌治疗时间<3个月与>3个月组的3年总生存率不同,分别为75%和95%(χ~2=5.45,P=0.020);phoenix定义生化失败组与无生化失败组的5年总生存率不同,分别为71%与92%(χ~2=8.83,P=0.003).结论 新辅助内分泌治疗时间至少达3个月,调强放疗的开始时机应在内分泌治疗未发生生化失败前.

The survival analysis on localized prostate cancer treated with neoadjuvant endocrine therapy followed by intensity modulated radiation therapy

Objective To restrospectively investigate clinical outcomes and prognositic factors in localized prostate cancer treated with neoadjuvant endocrine therapy followed by intensity modulated radiotherapy (IMRT). Methods Between March 2003 and October 2008, 54 localized prostate cancer treated by IMRT were recruited. All patients had received endocrine therapy before IMRT. The endocrine therapy included surgical castration or medical castration in combination with antiandrogens. The target of IMRT was the prostate and seminal vesicles with or without pelvis. The biochemical failure was defined according to the phoenix definition. By using the risk grouping standard proposed by D'Amico, patients were divided into three groups: low-risk group (n = 5), intermediate-risk group (n = 12), and high-risk group (n = 37). Kaplan-Meier method was used to calculate the overall survival rate. Prognostic factors were analyzed by univariate and multiple Cox regression analysis. Results The follow-up rate was 98%. The number of patients under follow-up was 39 at 3 years and 25 at 5 years. Potential prognostic factors, including risk groups, mode of endocrine therapy, time of endocrine therapy, phoenix grouping before IMRT, the prostate specific antigen doubling time (PSADT) before radiotherapy, PSA value before IMRT, interval of endocrine therapy and IMRT, irradiation region, and irradiation dose were analyzed by survival analysis. In univariate analysis, time of endocrine therapy (75 % vs 95 %, χ~2= 6. 45, P = 0. 011), phoenix grouping before IMRT (87% vs 96%, χ~2 = 4. 36, P = 0. 037), interval of endocrine therapy and IMRT (80% vs 95% ,χ~2= 11.60,P= 0. 001) ,irradiationdose(75% vs 91% ,χ~2=5.92,P= 0. 015) were statisticallysignificant prognostic factors for3 - year overall survival , and risk groups (85 vs 53 vs 29 , χ~2= 6. 40,P =0. 041) and PSADT before IMRT (62 vs 120, U =24. 50,P =0. 003) were significant factors for the median survival time. In the multiple Cox regression model, only time of endocrine therapy and phoenix grouping before IMRT were significantly related to the overall survival. The 3-year overall survival rates in patients with endocrine therapy less than 3 months versus more than 3 months were 75% versus 95% (χ~2= 5.45, P= 0.020). The 5-year overall survival rates in patients with biochemical failure versus nobiochemieal failure was 71% versus 92% (χ~2= 8.83 , P= 0.003) Conclusions Neoadjuvant endocrine therapy should last at least three months. Intensity modulate radiotherapy should start before biochemical failure after the endocrine therapy.