單一機構研究178位患者前列腺癌海福刀治療術後的生化復發預測因子
陳柏諺、柳易揚、江博暉、莊燿吉、李偉嘉、鄭元佐、陳彥達、徐淳建
高雄長庚紀念醫院 泌尿科
Predictors of PSA biochemical recurrence in patients undergoing primary whole gland prostate ablation with high intensity focused ultrasound in 178 patients
Po Yen Chen, Yi Yang Liu, Po Hui Chiang, Yao Chi Chuang, Wei Chia Lee,
Yuan Tso Cheng, Yen Ta Chen, Chun Chien Hsu
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Purpose: To identify the predictive factors of biochemical recurrence after prostate high intensity focused ultrasound (HIFU) treatment for localized prostate cancer.
Materials and Methods: We reviewed 178 patients who underwent primary whole gland prostate ablation with HIFU for localized prostate cancer from December 2009 to March 2015. The perioperative parameters included age, the stage of operation, preoperative prostate volume, initial PSA (iPSA), Gleason score, T stage, D’Amico risk group, postoperative PSA nadir, time to PSA nadir and PSA biochemical recurrence, defined by Phoenix definition (nadir plus 2) ng/mL. ROC analysis was used for the best cut-off values of PSA nadir for PSA biochemical recurrence. The parameters were analyzed in Cox proportional hazards regression and Kaplan-Meier analysis. for PSA biochemical recurrence.
Results: A total of 27.5% (N = 44) patients had PSA biochemical recurrence after HIFU during the median follow up of 32.35 ± 15.47 months. The median PSA biochemical recurrence-free survival and time to PSA biochemical recurrence were 24.89 ± 17.05 months and 2.67 ± 2.23 months respectively. Cox proportional hazards regression revealed Gleason score ≥7 (Gleason score=7, HR=3.48, p=0.012; Gleason score ≥8, HR=4.11, p=0.004), Stage >T2b (HR=2.80, p=0.009) and PSA nadir (HR=1.44, p<0.001) was statistically significant for PSA biochemical recurrence while there was no statistics significant in prostate volume (p=0.264). ROC analysis revealed the best cut-off values for biochemical recurrence prediction were PSA nadir cut-off values of 0.39 ng/mL revealed the best AUC with 60.5% sensitivity and 80.3% specificity for PSA biochemical recurrence.
Conclusion: Postoperative PSA nadir > 0.39ng/mL predicts biochemical recurrence in primary whole prostate gland HIFU treatment. Also, Gleason score ≥7, Stage > T2b might be associated with unfavorable outcomes. These results will provide useful information for urological oncologists in daily practice.