https://scholars.lib.ntu.edu.tw/handle/123456789/485653
標題: | The outcome and prognostic factors for lymph node recurrence after node-sparing definitive external beam radiotherapy for localized prostate cancer | 作者: | Wang Y.-J. CHAO-YUAN HUANG Hou W.-H. CHIA-CHUN WANG KENG-HSUEH LAN CHUNG-HSIN CHEN HONG-JENG YU Lai M.-K. ANN-LII CHENG SHIH-PING LIU YEONG-SHIAU PU CHIA-HSIEN CHENG |
公開日期: | 2015 | 出版社: | BioMed Central Ltd. | 卷: | 13 | 期: | 1 | 來源出版物: | World Journal of Surgical Oncology | 摘要: | Background: The prognostic factors for the recurrence of lymph node (LN) metastasis after dose-escalated radiotherapy (RT) in prostate cancer patients have not been well investigated. We report the prognostic factors and outcomes in patients receiving salvage treatment for LN recurrence after high-dose intensity-modulated RT (IMRT). Methods: We studied a cohort of 419 patients with localized prostate adenocarcinoma undergoing definitive IMRT (78 Gy). LN recurrence was diagnosed by size criteria using computed tomography (CT) or magnetic resonance imaging, or abnormal uptake of 18F-fluorocholine by LNs on positron emission tomography/CT. Overall survival and LN recurrence-free survival (LNRFS) were calculated, and prognostic factors were evaluated. Results: With a median follow-up of 60 months, 18 patients (4.3 %) had LN recurrence and a significantly lower 5-year overall survival rate (60 vs. 90 %, p = 0.003). Univariate analysis showed that T3/T4 stage (p = 0.003), Gleason score >7 (p < 0.001), and estimated risk of pelvic LN involvement of >30 % by the Roach formula (p = 0.029) were associated with significantly lower LNRFS. On multivariate analysis, high Gleason score (hazard ratio = 5.99, p = 0.007) was the only independent factor. The 1/2-year overall survivals after LN recurrence were 67/54 %. Patients with isolated LN recurrence (p = 0.003), prostate-specific antigen (PSA) doubling time >5 months (p = 0.009), interval between PSA nadir and biochemical failure >12 months (p = 0.035), and PSA <10 ng/ml at LN recurrence (p = 0.003) had significantly better survival. Patients with isolated LN recurrence had significantly better survival when treated with combined RT and hormones than when treated with hormones alone (p = 0.011). Conclusions: Gleason score of >7 may predict LN recurrence in prostate cancer patients treated with definitive IMRT. Small number of patients limits the extrapolation of this risk with the primary treatment strategy. Combined RT and hormones may prolong survival in patients with isolated LN recurrence. ? 2015 Wang et al. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84946549659&doi=10.1186%2fs12957-015-0721-4&partnerID=40&md5=31bd34d14e741fa8ebf83f79f804c176 https://scholars.lib.ntu.edu.tw/handle/123456789/485653 |
ISSN: | 1477-7819 | DOI: | 10.1186/s12957-015-0721-4 | SDG/關鍵字: | fluorocholine f 18; prostate specific antigen; radiopharmaceutical agent; unclassified drug; aged; Article; biochemical recurrence; bone metastasis; cancer mortality; cancer prognosis; cancer recurrence; cancer risk; cancer staging; computer assisted emission tomography; controlled study; disease association; external beam radiotherapy; Gleason score; human; lymph node metastasis; major clinical study; male; nuclear magnetic resonance imaging; overall survival; prostate adenocarcinoma; radiation dose; recurrence free survival; survival time; treatment failure; adenocarcinoma; cancer grading; follow up; intensity modulated radiation therapy; mortality; pathology; prognosis; Prostatic Neoplasms; salvage therapy; survival rate; tumor recurrence; Adenocarcinoma; Aged; Follow-Up Studies; Humans; Male; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Prostatic Neoplasms; Radiotherapy, Intensity-Modulated; Salvage Therapy; Survival Rate |
顯示於: | 腫瘤醫學研究所 |
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