挽救性根治性前列腺切除术后持续 PSA 的影响：一项多中心研究,Prostate Cancer and Prostatic Diseases

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挽救性根治性前列腺切除术后持续 PSA 的影响：一项多中心研究
Prostate Cancer and Prostatic Diseases ( IF 5.1 ) Pub Date : 2023-10-06 , DOI: 10.1038/s41391-023-00728-5
Felix Preisser _{1,

2} , Reha-Baris Incesu ₁ , Pawel Rajwa _{3,

4} , Marcin Chlosta ₃ , Florian Nohe ₁ , Mohamed Ahmed ₅ , Andre Luis Abreu ₆ , Giovanni Cacciamani ₆ , Luis Ribeiro ₇ , Alexander Kretschmer ₈ , Thilo Westhofen ₈ , Joseph A Smith ₉ , Thomas Steuber ₁ , Giorgio Calleris ₁₀ , Yannic Raskin ₁₁ , Paolo Gontero ₁₀ , Steven Joniau ₁₁ , Rafael Sanchez-Salas ₁₂ , Shahrokh F Shariat _{3,

13,

14,

15,

16} , Inderbir Gill ₆ , R Jeffrey Karnes ₅ , Paul Cathcart ₇ , Henk Van Der Poel ₁₇ , Giancarlo Marra ₁₀ , Derya Tilki _{1,

18,

19}

Affiliation

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
Department of Urology, Medical University of Vienna, Vienna, Austria.
Department of Urology, Medical University of Silesia, Zabrze, Poland.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Keck Medical Center of USC, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.
Urology Centre, Guy's Hospital, London, UK.
Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany.
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Surgical Sciences, San Giovanni Battista Hospital and University of Turin, Turin, Italy.
Department of Urology, University Hospitals Leuven, Leuven, Belgium.
Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.
Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, Koc University Hospital, Istanbul, Turkey.

背景和目标

持续性前列腺特异性抗原（PSA）是根治性前列腺切除术（RP）后复发的不良预后因素。然而，持续性 PSA 对接受挽救性 RP 的患者肿瘤学结果的影响尚不清楚。旨在研究挽救性 RP 后持续 PSA 对长期肿瘤学结果的影响。

材料与方法

从 12 个高容量中心中确定了 2000 年至 2021 年间因复发性前列腺癌而接受挽救性 RP 的患者。仅纳入挽救性 RP 后具有可用 PSA 的患者。Kaplan-Meier 分析和多变量 Cox 回归模型用于测试持续 PSA 对生化复发 (BCR)、转移和挽救 RP 后死亡的影响。持续 PSA 定义为挽救 RP 后第一次 PSA 测量时 PSA 值≥ 0.1 ng/ml。

结果

总共确定了 580 名患者。其中，42% (n = 242) 患有持续性 PSA。挽救 RP 后的中位随访时间为 38 个月，挽救 RP 的中位时间为 64 个月，挽救 RP 后首次 PSA 的中位时间为 2.2 个月。挽救 RP 后 84 个月时，对于挽救 RP 后 PSA 持续存在与检测不到的患者，无 BCR、无转移，总生存率为 6.6 vs. 59%、71 vs. 88% 和 77 vs. 94%（全部< 0.01）。在多变量 Cox 模型中，持续 PSA 是 BCR（HR：5.47，p < 0.001）和死亡（HR：3.07，p < 0.01）的独立预测因子。

结论

挽救性 RP 后持续的 PSA 很常见，是更差肿瘤结果的独立预测因素。接受挽救性 RP 的患者在手术后应密切监测，以识别那些患有持续性 PSA 的患者。

"点击查看英文标题和摘要"

Impact of persistent PSA after salvage radical prostatectomy: a multicenter study

Background and objective

Persistent prostatic specific antigen (PSA) represents a poor prognostic factor for recurrence after radical prostatectomy (RP). However, the impact of persistent PSA on oncologic outcomes in patients undergoing salvage RP is unknown. To investigate the impact of persistent PSA after salvage RP on long-term oncologic outcomes.

Material and methods

Patients who underwent salvage RP for recurrent prostate cancer between 2000 and 2021 were identified from twelve high-volume centers. Only patients with available PSA after salvage RP were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of persistent PSA on biochemical recurrence (BCR), metastasis and any death after salvage RP. Persistent PSA was defined as a PSA-value ≥ 0.1 ng/ml, at first PSA-measurement after salvage RP.

Results

Overall, 580 patients were identified. Of those, 42% (n = 242) harbored persistent PSA. Median follow-up after salvage RP was 38 months, median time to salvage RP was 64 months and median time to first PSA after salvage RP was 2.2 months. At 84 months after salvage RP, BCR-free, metastasis-free, and overall survival was 6.6 vs. 59%, 71 vs. 88% and 77 vs. 94% for patients with persistent vs. undetectable PSA after salvage RP (all p < 0.01). In multivariable Cox models persistent PSA was an independent predictor for BCR (HR: 5.47, p < 0.001) and death (HR: 3.07, p < 0.01).

Conclusion

Persistent PSA is common after salvage RP and represents an independent predictor for worse oncologic outcomes. Patients undergoing salvage RP should be closely monitored after surgery to identify those with persistent PSA.

更新日期：2023-10-06

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