Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009 USA.
Cancer J. 2012 Jan-Feb;18(1):1-8. doi: 10.1097/PPO.0b013e3182467419.
This study aimed to evaluate the changes in outcome for men with localized prostate cancer treated with definitive external beam radiation therapy during a 20-year period at a comprehensive cancer center.
We categorized 2675 men with prostate cancer treated at MD Anderson Cancer Center with definitive external beam radiation therapy with or without androgen deprivation therapy into 3 treatment eras: 1987 to 1993 (n = 722), 1994 to 1999 (n = 828), and 2000 to 2007 (n = 1125). To help adjust for stage migration, patients were stratified according to risk group as defined by the National Comprehensive Cancer Network. Biochemical (Phoenix definition), local, distant, and any clinical failure, prostate-cancer specific survival, and overall survival were analyzed according to the Kaplan-Meier method.
Median age was 68.5 years and median follow-up was 6.4 years. Fewer men in the most recent era had high-risk disease, and a higher proportion received 72 Gy or higher (99% vs 4%) and androgen deprivation therapy (60% vs 6%) than the earliest era. All risk groups treated in the modern era experienced improved rates of biochemical, local, and distant failure. In high-risk patients, decreased rates of distant failure and clinical failure led to improved prostate cancer-specific survival and overall survival. Local control was improved for intermediate- and high-risk patients, with a trend toward improvement in low-risk patients. On multivariate analysis, recent treatment era was closely correlated with a dose of 72 Gy or higher and treatment with androgen deprivation therapy and predicted for lower rates of biochemical, local, and distant failure. Androgen deprivation therapy, higher dose, and more recent treatment era predicted for improved prostate cancer-specific survival.
During the last 20 years of prostate cancer irradiation, disease control outcomes have improved in all patients, leading to improved prostate cancer-specific survival and overall survival for men with high-risk disease. This may reflect advances in workup, staging accuracy, and prostate cancer treatment in the modern era.
本研究旨在评估在综合性癌症中心，20 年间采用外照射根治性放疗治疗局限性前列腺癌患者的结局变化。
我们将在 MD 安德森癌症中心接受根治性外照射放疗联合或不联合雄激素剥夺治疗的 2675 例前列腺癌患者分为 3 个治疗时代：1987 年至 1993 年（n = 722）、1994 年至 1999 年（n = 828）和 2000 年至 2007 年（n = 1125）。为了帮助调整分期迁移，根据国家综合癌症网络定义的风险组对患者进行分层。采用 Kaplan-Meier 法分析生化（Phoenix 定义）、局部、远处和任何临床失败、前列腺癌特异性生存和总生存。
中位年龄为 68.5 岁，中位随访时间为 6.4 年。最近一个时代的高危疾病患者比例较低，接受 72Gy 或更高剂量（99%对 4%）和雄激素剥夺治疗（60%对 6%）的患者比例高于最早的时代。现代时代治疗的所有风险组都改善了生化、局部和远处失败的发生率。高危患者远处失败和临床失败率降低，导致前列腺癌特异性生存和总生存改善。中高危患者局部控制得到改善，低危患者有改善趋势。多变量分析显示，最近的治疗时代与 72Gy 或更高剂量以及雄激素剥夺治疗密切相关，且与生化、局部和远处失败发生率较低相关。雄激素剥夺治疗、更高剂量和更现代的治疗时代与改善的前列腺癌特异性生存相关。
在过去 20 年的前列腺癌放疗中，所有患者的疾病控制结局均得到改善，导致高危疾病患者的前列腺癌特异性生存和总生存得到改善。这可能反映了现代时代的检查、分期准确性和前列腺癌治疗的进步。
