Division of Urology, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA.
J Urol. 2012 Apr;187(4):1259-65. doi: 10.1016/j.juro.2011.11.084. Epub 2012 Feb 14.
Radical prostatectomy, external beam radiotherapy and brachytherapy are accepted treatments for localized prostate cancer. However, it is unknown if survival differences exist among treatments. We analyzed the survival of patients treated with these modalities according to contemporary standards.
A total of 10,429 consecutive patients with localized prostate cancer treated with radical prostatectomy (6,485), external beam radiotherapy (2,264) or brachytherapy (1,680) were identified. Multivariable regression analyses were used to model the disease (biopsy grade, clinical stage, prostate specific antigen) and patient specific (age, ethnicity, comorbidity) parameters for overall survival and prostate cancer specific mortality. Propensity score analysis was used to adjust for differences in observed background characteristics.
The adjusted 10-year overall survival after radical prostatectomy, external beam radiotherapy and brachytherapy was 88.9%, 82.6% and 81.7%, respectively. Adjusted 10-year prostate cancer specific mortality was 1.8%, 2.9% and 2.3%, respectively. Using propensity score analysis, external beam radiotherapy was associated with decreased overall survival (HR 1.6, 95% CI 1.4-1.9, p<0.001) and increased prostate cancer specific mortality (HR 1.5, 95% CI 1.0-2.3, p=0.041) compared to radical prostatectomy. Brachytherapy was associated with decreased overall survival (HR 1.7, 95% CI 1.4-2.1, p<0.001) but not prostate cancer specific mortality (HR 1.3, 95% CI 0.7-2.4, p=0.5) compared to radical prostatectomy.
After adjusting for major confounders, radical prostatectomy was associated with a small but statistically significant improvement in overall and cancer specific survival. These survival differences may arise from an imbalance of confounders, differences in treatment related mortality and/or improved cancer control when radical prostatectomy is performed as initial therapy.
根治性前列腺切除术、外照射放疗和近距离放疗是治疗局限性前列腺癌的公认方法。然而，目前尚不清楚这些治疗方法的生存结果是否存在差异。我们根据当代标准分析了采用这些方法治疗的患者的生存情况。
共确定了 10429 例接受根治性前列腺切除术（6485 例）、外照射放疗（2264 例）或近距离放疗（1680 例）治疗的局限性前列腺癌连续患者。多变量回归分析用于对总生存和前列腺癌特异性死亡率的疾病（活检分级、临床分期、前列腺特异性抗原）和患者特定（年龄、种族、合并症）参数进行建模。采用倾向评分分析来调整观察到的背景特征差异。
根治性前列腺切除术、外照射放疗和近距离放疗后的 10 年总生存率分别为 88.9%、82.6%和 81.7%。调整后的 10 年前列腺癌特异性死亡率分别为 1.8%、2.9%和 2.3%。采用倾向评分分析，与根治性前列腺切除术相比，外照射放疗与总生存降低相关（HR 1.6，95%CI 1.4-1.9，p<0.001）和前列腺癌特异性死亡率增加（HR 1.5，95%CI 1.0-2.3，p=0.041）。与根治性前列腺切除术相比，近距离放疗与总生存降低相关（HR 1.7，95%CI 1.4-2.1，p<0.001），但与前列腺癌特异性死亡率无关（HR 1.3，95%CI 0.7-2.4，p=0.5）。
在校正了主要混杂因素后，根治性前列腺切除术与总生存和癌症特异性生存的微小但具有统计学意义的改善相关。这些生存差异可能源于混杂因素的不平衡、与治疗相关的死亡率差异以及初始治疗采用根治性前列腺切除术时癌症控制的改善。
