局限性前列腺癌男性患者接受初次雄激素剥夺治疗后的生存率
Survival following primary androgen deprivation therapy among men with localized prostate cancer.
作者信息
Lu-Yao Grace L, Albertsen Peter C, Moore Dirk F, Shih Weichung, Lin Yong, DiPaola Robert S, Yao Siu-Long
机构信息
Department of Environmental and Occupational Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
出版信息
JAMA. 2008 Jul 9;300(2):173-81. doi: 10.1001/jama.300.2.173.
CONTEXT
Despite a lack of data, increasing numbers of patients are receiving primary androgen deprivation therapy (PADT) as an alternative to surgery, radiation, or conservative management for the treatment of localized prostate cancer.
OBJECTIVE
To evaluate the association between PADT and survival in elderly men with localized prostate cancer.
DESIGN, SETTING, AND PATIENTS: A population-based cohort study of 19,271 men aged 66 years or older receiving Medicare who did not receive definitive local therapy for clinical stage T1-T2 prostate cancer. These patients were diagnosed in 1992-2002 within predefined US geographical areas, with follow-up through December 31, 2006, for all-cause mortality and through December 31, 2004, for prostate cancer-specific mortality. Instrumental variable analysis was used to address potential biases associated with unmeasured confounding variables.
MAIN OUTCOME MEASURES
Prostate cancer-specific survival and overall survival.
RESULTS
Among patients with localized prostate cancer (median age, 77 years), 7867 (41%) received PADT, and 11,404 were treated with conservative management, not including PADT. During the follow-up period, there were 1560 prostate cancer deaths and 11,045 deaths from all causes. Primary androgen deprivation therapy was associated with lower 10-year prostate cancer-specific survival (80.1% vs 82.6%; hazard ratio [HR], 1.17; 95% confidence interval [CI], 1.03-1.33) and no increase in 10-year overall survival (30.2% vs 30.3%; HR, 1.00; 95% CI, 0.96-1.05) compared with conservative management. However, in a prespecified subset analysis, PADT use in men with poorly differentiated cancer was associated with improved prostate cancer-specific survival (59.8% vs 54.3%; HR, 0.84; 95% CI, 0.70-1.00; P = .049) but not overall survival (17.3% vs 15.3%; HR, 0.92; 95% CI, 0.84-1.01).
CONCLUSION
Primary androgen deprivation therapy is not associated with improved survival among the majority of elderly men with localized prostate cancer when compared with conservative management.
背景
尽管缺乏数据，但越来越多的患者正在接受原发性雄激素剥夺疗法（PADT），作为手术、放疗或保守治疗局限性前列腺癌的替代方案。
目的
评估PADT与老年局限性前列腺癌患者生存率之间的关联。
设计、地点和患者：一项基于人群的队列研究，研究对象为19271名年龄在66岁及以上的接受医疗保险的男性，这些男性未接受临床分期为T1-T2前列腺癌的确定性局部治疗。这些患者于1992年至2002年在美国预先定义的地理区域内被诊断，随访至2006年12月31日以获取全因死亡率，随访至2004年12月31日以获取前列腺癌特异性死亡率。使用工具变量分析来解决与未测量的混杂变量相关的潜在偏差。
主要观察指标
前列腺癌特异性生存率和总生存率。
结果
在局限性前列腺癌患者（中位年龄77岁）中，7867名（41%）接受了PADT，11404名接受了保守治疗，不包括PADT。在随访期间，有1560例前列腺癌死亡和11045例全因死亡。与保守治疗相比，原发性雄激素剥夺疗法与10年前列腺癌特异性生存率较低相关（80.1%对82.6%；风险比[HR]，1.17；95%置信区间[CI]，1.03-1.33），且10年总生存率未增加（30.2%对30.3%；HR，1.00；95%CI，0.96-1.05）。然而，在预先指定的亚组分析中，低分化癌男性使用PADT与改善前列腺癌特异性生存率相关（59.8%对54.3%；HR，0.84；95%CI，0.70-1.00；P = 0.049），但与总生存率无关（17.3%对15.3%；HR，0.92；95%CI，0.84-1.01）。
结论
与保守治疗相比，原发性雄激素剥夺疗法在大多数老年局限性前列腺癌患者中并未改善生存率。
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