Jani Ashesh B, Sokoloff Mitchell, Shalhav Arieh, Stadler Walter
Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois 60637, USA.
Urology. 2004 Nov;64(5):976-81. doi: 10.1016/j.urology.2004.06.024.
To quantify the benefits and harm of androgen ablation (AA) adjuvant to radiotherapy in the postprostatectomy setting. AA is commonly used in the management of prostate cancer.
A literature review was performed to estimate the absolute biochemical control advantage for the use of AA concomitant with postprostatectomy external beam radiotherapy. Additionally, a model was developed, with supporting published data, to estimate the utility-adjusted survival detriment due to the side effects of AA, using the number needed to treat (NNT) technique. Using these data, the unadjusted NNTs and the utility-adjusted NNTs for the addition of AA were computed. In all cases, the sign and magnitude of the NNTs obtained were used to gauge the effects of AA.
The unadjusted NNT analysis demonstrated very low values (far less than 20), suggesting a strong benefit for the use of AA, in both adjuvant and salvage radiotherapy settings. Even after adjustment for hormone-induced functional loss, a significant advantage of AA was demonstrated.
Using the complication-adjusted NNT method, AA appears to be advantageous in both adjuvant and salvage postprostatectomy radiotherapy settings. The results of the present investigation demonstrated the significant role of the NNT technique for uro-oncologic management decisions when treatment complications need to be considered and balanced against the beneficial effects of the treatment.
量化前列腺切除术后雄激素剥夺（AA）辅助放疗的益处与危害。AA常用于前列腺癌的治疗。
进行文献综述以评估AA联合前列腺切除术后体外放疗在生化控制方面的绝对优势。此外，利用已发表的支持性数据建立一个模型，采用需治疗人数（NNT）技术来估计因AA副作用导致的效用调整生存损害。利用这些数据，计算添加AA时的未调整NNT和效用调整NNT。在所有情况下，获得的NNT的正负及大小用于衡量AA的效果。
未调整的NNT分析显示数值极低（远低于20），表明在辅助放疗和挽救性放疗中使用AA均有显著益处。即使在对激素诱导的功能丧失进行调整后，AA的显著优势依然存在。
采用并发症调整的NNT方法，AA在前列腺切除术后辅助放疗和挽救性放疗中似乎均有益处。本研究结果表明，在需要考虑治疗并发症并与治疗的有益效果相权衡时，NNT技术在泌尿肿瘤管理决策中具有重要作用。
