- 作者：Sean M. Vance ; M.S.&lowast ; ; Matthew H. Stenmark ; M.D.&lowast ; ; Kevin Blas ; B.A.&lowast ; ; Schulyer Halverson ; B.A.&lowast ; ; Daniel A. Hamstra ; M.D. ; Ph.D.&lowast ; ; dhamm@umich.edu ; ffeng@umich.edu ; Felix Y. Feng ; M.D.&lowast ; ; &dagger ;
- 关键词：Prostate cancer ; Biopsy ; Prognostic factors ; Tumor percentage ; Tumor length ; Radiotherapy
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 期刊代码：136_03603016
- 类别：med
- 出版时间：1 July, 2012
- 卷：83
- 期：3
- 页码：940-946
- 文件大小：366 K
Purpose
To investigate the prognostic utility of the percentage of cancer volume (PCV) in needle biopsy specimens for prostate cancer patients treated with dose-escalated external beam radiotherapy.Methods and Materials
The outcomes were analyzed for 599 men treated for localized prostate cancer with external beam radiotherapy to a minimal planning target volume dose of 75 Gy (range, 75-79.2). We assessed the effect of PCV and the pretreatment and treatment-related factors on the freedom from biochemical failure, freedom from metastasis, cause-specific survival, and overall survival.
Results
The median number of biopsy cores was 7 (interquartile range, 6-12), median PCV was 10%(interquartile range, 2.5-25%), and median follow-up was 62 months. The PCV correlated with the National Comprehensive Cancer Network risk group and individual risk features, including T stage, prostate-specific antigen level, Gleason score, and percentage of positive biopsy cores. On log-rank analysis, the PCV stratified by quartile was prognostic for all endpoints, including overall survival. In addition, the PCV was a stronger prognostic factor than the percentage of positive biopsy cores when the two metrics were analyzed together. On multivariate analysis, the PCV predicted a worse outcome for all endpoints, including freedom from biochemical failure, (hazard ratio, 1.9;
Conclusions
For patients treated with dose-escalated external beam radiotherapy, the volume of cancer in the biopsy specimen adds prognostic value for clinically relevant endpoints, particularly in intermediate- and high-risk patients. Although the PCV determination is more arduous than the percentage of positive biopsy cores, it provides superior risk stratification.