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。
Impact of persistent PSA after salvage radical prostatectomy: a multicenter study.
发表日期：2023 Oct 06
作者：
Felix Preisser, Reha-Baris Incesu, Pawel Rajwa, Marcin Chlosta, Florian Nohe, Mohamed Ahmed, Andre Luis Abreu, Giovanni Cacciamani, Luis Ribeiro, Alexander Kretschmer, Thilo Westhofen, Joseph A Smith, Thomas Steuber, Giorgio Calleris, Yannic Raskin, Paolo Gontero, Steven Joniau, Rafael Sanchez-Salas, Shahrokh F Shariat, Inderbir Gill, R Jeffrey Karnes, Paul Cathcart, Henk Van Der Poel, Giancarlo Marra, Derya Tilki
来源：
PROSTATE CANCER AND PROSTATIC DISEASES
摘要：
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。从 12 个大容量中心中筛选出 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 被定义为 PSA 值 ≥ 0.1 ng/ml，在抢救 RP 后首次进行 PSA 测量。总共确定了 580 名患者。其中，42% (n = 242) 具有持续的 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，持续性 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。持续性 PSA 在抢救 RP 后很常见，是更差肿瘤结果的独立预测因子。接受挽救性 RP 的患者应在手术后受到密切监测，以识别那些患有持续性 PSA 的患者。© 2023。作者。
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.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.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).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.© 2023. The Author(s).