D'Amico A V, Schultz D, Loffredo M, Dugal R, Hurwitz M, Kaplan I, Beard C J, Renshaw A A, Kantoff P W
Brigham and Women's Hospital and Dana Farber Cancer Institute, Department of Radiation Therapy, Harvard Medical School, 75 Francis St, L-2 Level, Boston, MA 02115, USA.
JAMA. 2000 Sep 13;284(10):1280-3. doi: 10.1001/jama.284.10.1280.
Combined treatment using radiation therapy (RT) and androgen suppression therapy (AST) is used to treat men with clinically localized adenocarcinoma of the prostate, but outcome using this combined therapy compared with RT alone is not known.
To determine the relative efficacy of RT plus AST vs RT alone among men with clinically localized prostate cancer.
DESIGN, SETTING, AND PATIENTS: Retrospective cohort study of 1586 men with prostate cancer who were treated between January 1989 and August 1999 using 3-dimensional conformal RT with (n = 276) or without (n = 1310) 6 months of AST.
Relative risk (RR) of prostate-specific antigen (PSA) failure (defined according to the American Society for Therapeutic Radiology and Oncology consensus statement), by treatment and high-, intermediate-, or low-risk group based on serum PSA level, biopsy Gleason score, and 1992 American Joint Commission on Cancer clinical tumor category.
Estimates of 5-year PSA outcome after RT with or without AST were not statistically different among low-risk patients (P =.09), whereas intermediate- and high-risk patients treated with RT plus AST had significantly better outcomes than those treated with RT alone (P<.001 and =.009, respectively). The RR of PSA failure in low-risk patients treated with RT plus AST was 0.5 (95% confidence interval [CI], 0.3-1.1) compared with patients treated with RT alone. The RRs of PSA failure in intermediate-risk and high-risk patients treated with RT plus AST compared with RT alone were 0.2 (95% CI, 0. 1-0.3) and 0.4 (95% CI, 0.2-0.8), respectively.
Our data suggest a significant benefit in 5-year PSA outcomes for men with clinically localized prostate cancer in intermediate- and high-risk groups treated with RT plus AST vs those treated with RT alone. Results from prospective randomized trials currently under way are needed to validate these findings. JAMA. 2000;284:1280-1283
放射治疗（RT）与雄激素抑制治疗（AST）联合应用于临床局限性前列腺腺癌男性患者的治疗，但与单纯放射治疗相比，这种联合治疗的效果尚不清楚。
确定在临床局限性前列腺癌男性患者中，RT联合AST与单纯RT相比的相对疗效。
设计、地点和患者：对1586例前列腺癌男性患者进行回顾性队列研究，这些患者在1989年1月至1999年8月期间接受了三维适形放疗，其中276例接受了6个月的AST，1310例未接受。
根据治疗方式以及基于血清前列腺特异抗原（PSA）水平、活检Gleason评分和1992年美国癌症联合委员会临床肿瘤分类的高、中、低风险组，前列腺特异抗原（PSA）失败的相对风险（RR）（根据美国放射治疗及肿瘤学会共识声明定义）。
低风险患者接受或未接受AST的RT后5年PSA结果的估计无统计学差异（P = 0.09），而接受RT联合AST治疗的中、高风险患者的结果明显优于单纯接受RT治疗的患者（分别为P<0.001和P = 0.009）。与单纯接受RT治疗的患者相比，接受RT联合AST治疗的低风险患者PSA失败的RR为0.5（95%置信区间[CI]，0.3 - 1.1）。与单纯RT相比，接受RT联合AST治疗的中风险和高风险患者PSA失败的RR分别为0.2（95%CI，0.1 - 0.3）和0.4（95%CI，0.2 - 0.8）。
我们的数据表明，对于临床局限性前列腺癌的中、高风险组男性患者，RT联合AST治疗与单纯RT治疗相比，5年PSA结果有显著益处。需要目前正在进行的前瞻性随机试验结果来验证这些发现。《美国医学会杂志》。2000年；284：1280 - 1283
