Lee W Robert, Sharkey Jerrold, Cowan Janet E, DuChane Janeen, Carroll Peter R
Department of Radiation Oncology, Duke University School of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Brachytherapy. 2007 Apr-Jun;6(2):123-8. doi: 10.1016/j.brachy.2007.01.007.
The purpose of this study was to describe demographic and clinical characteristics in a large disease registry of prostate cancer patients treated with prostate brachytherapy (PB) and to identify factors influencing the use of supplemental external beam (SEB) radiation therapy and choice of isotope.
Data were abstracted from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a disease registry of 11,804 men with various stages of prostate cancer. The study population consisted of those men who were diagnosed with prostate cancer between 1990 and 2003, had no prior history of cancer and were treated with PB (alone or with SEB). The influence of patient demographics, disease characteristics, and year of diagnosis on the use of SEB and isotope choice was examined.
The study population included 791 men. Six hundred nine men (77%) were treated with PB alone and 182 men (23%) were treated with PB and SEB. Patient demographics were not associated with the use of SEB. Disease characteristics were associated with the use of SEB. Patients treated with PB and SEB had higher pretreatment prostate-specific antigen (PSA), higher T-stage, higher Gleason score, and were more likely to be placed in the high-risk category (all p<0.01). The use of SEB increased over the period studied. In a multivariate analysis, patients diagnosed after 1999 were much more likely to receive SEB after controlling for disease characteristics (PSA, T-stage, Gleason). Likewise, higher clinical PSA (odds ratio [OR]=1.08; 95% confidence interval [CI]: 1.04-1.13), higher biopsy Gleason (OR=3.64; 95% CI: 2.60-5.09), and cT2 vs. cT1 (OR=2.06; 95% CI: 1.22-3.48) were more likely to have PB with SEB than PB alone. Patient demographics differed according to isotope. Compared to men treated with 125)I, men treated with (103)Pd were older, less educated, less wealthy, and less likely to have private insurance. Disease characteristics also differed according to isotope. Compared to men treated with 125I, men treated with 103Pd had higher T-stages, higher Gleason scores, and were more likely to be placed in the intermediate- or high-risk category. The choice of isotope did not change over time.
The use of SEB is associated with disease characteristics. SEB has increased over the period studied. Isotope choice is associated with patient demographics and disease characteristics.
本研究的目的是描述接受前列腺近距离放射治疗（PB）的前列腺癌患者大型疾病登记中的人口统计学和临床特征，并确定影响补充外照射（SEB）放疗使用和同位素选择的因素。
数据摘自前列腺癌战略泌尿学研究计划（CaPSURE），这是一个有11,804名处于不同前列腺癌阶段男性的疾病登记库。研究人群包括那些在1990年至2003年期间被诊断为前列腺癌、无癌症既往史且接受PB治疗（单独或联合SEB）的男性。研究了患者人口统计学、疾病特征和诊断年份对SEB使用和同位素选择的影响。
研究人群包括791名男性。609名男性（77%）仅接受PB治疗，182名男性（23%）接受PB和SEB治疗。患者人口统计学与SEB的使用无关。疾病特征与SEB的使用有关。接受PB和SEB治疗的患者治疗前前列腺特异性抗原（PSA）更高、T分期更高、Gleason评分更高，且更有可能被归为高危类别（所有p<0.01）。在研究期间，SEB的使用有所增加。在多变量分析中，在控制疾病特征（PSA、T分期、Gleason）后，1999年以后诊断的患者接受SEB的可能性要高得多。同样，临床PSA水平较高（优势比[OR]=1.08；95%置信区间[CI]：1.04 - 1.13）、活检Gleason评分较高（OR=3.64；95% CI：2.60 - 5.09）以及cT2期与cT1期相比（OR=2.06；95% CI：1.22 - 3.48）的患者接受PB联合SEB治疗的可能性比仅接受PB治疗的可能性更大。患者人口统计学根据同位素不同而有所差异。与接受碘-125（¹²⁵I）治疗的男性相比，接受钯-103（¹⁰³Pd）治疗的男性年龄更大、受教育程度更低、财富更少且拥有私人保险的可能性更小。疾病特征也因同位素不同而有所差异。与接受¹²⁵I治疗的男性相比，接受¹⁰³Pd治疗的男性T分期更高、Gleason评分更高，且更有可能被归为中危或高危类别。同位素的选择在研究期间没有变化。
SEB的使用与疾病特征相关。在研究期间SEB有所增加。同位素选择与患者人口统计学和疾病特征相关。
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