Department of Radiation Oncology, Vancouver Cancer Clinic, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
Cancer. 2013 Apr 15;119(8):1537-46. doi: 10.1002/cncr.27911. Epub 2012 Dec 26.
The objective of this study was to report the rates of disease-free survival (DFS), cause-specific survival (CSS), and overall survival after low-dose-rate (LDR) prostate brachytherapy (PB).
Data from 1006 consecutive patients with prostate cancer who received LDR-PB and underwent implantation on or before October 23, 2003 were extracted from a prospective database on November 11, 2011. The selected patients had low-risk (58%) or intermediate-risk (42%) disease according to National Comprehensive Cancer Network criteria. The Phoenix threshold was used to define biochemical relapse. Sixty-five percent of patients received 3 months of neoadjuvant androgen-deprivation therapy (ADT) and 3 months of concomitant ADT. Univariate and multivariate analyses are reported in relation to patient, tumor, and treatment variables.
The median follow-up was 7.5 years. By using Fine and Gray competing risks analysis, the 5-year and 10-year actuarial DFS rates were 96.7% (95% confidence interval, 95.2%-97.7%) and 94.1% (95% confidence interval, 92%-95.6%), respectively. When applied to the whole cohort, none of the usual prognostic variables, including dose metrics, were correlated with DFS. However, in both univariate and multivariate models, increasing dose was the only covariate that correlated with improved DFS for the subset of men (N = 348) who did not receive ADT (P = .043). The actuarial 10-year CSS rate was 99.1% (95% confidence interval, 97.3%-99.7%). The overall survival rate was 93.8% at 5 years (95% confidence interval, 92%-95.1%) and 83.5% at 10 years (95% confidence interval, 79.8%-86.6%). Only age at implantation (P = .0001) was correlated with overall survival in multivariate analysis.
In a consecutive cohort of 1006 men with National Comprehensive Cancer Network low-risk and intermediate-risk prostate cancer, the actuarial rate of recurrent disease after LDR-PB was approximately 3% at 5 years and 6% at 10 years.
本研究旨在报告低剂量率（LDR）前列腺近距离放射治疗（PB）后的无病生存率（DFS）、疾病特异性生存率（CSS）和总生存率。
2011 年 11 月 11 日，从一个前瞻性数据库中提取了 1006 例连续接受 LDR-PB 治疗且于 2003 年 10 月 23 日前接受植入术的前列腺癌患者的数据。根据国家综合癌症网络（NCCN）标准，所选患者的疾病为低危（58%）或中危（42%）。采用 Phoenix 标准定义生化复发。65%的患者接受了 3 个月的新辅助雄激素剥夺治疗（ADT）和 3 个月的同期 ADT。报告了单变量和多变量分析与患者、肿瘤和治疗变量的关系。
中位随访时间为 7.5 年。采用 Fine 和 Gray 竞争风险分析，5 年和 10 年的实际 DFS 率分别为 96.7%（95%置信区间，95.2%-97.7%）和 94.1%（95%置信区间，92%-95.6%）。当应用于整个队列时，包括剂量指标在内的所有常用预后变量均与 DFS 无相关性。然而，在单变量和多变量模型中，只有剂量是与未接受 ADT 的（N=348）男性亚组（N=348）DFS 改善相关的唯一协变量（P=0.043）。10 年的实际 CSS 率为 99.1%（95%置信区间，97.3%-99.7%）。5 年总生存率为 93.8%（95%置信区间，92%-95.1%），10 年总生存率为 83.5%（95%置信区间，79.8%-86.6%）。只有植入时的年龄（P=0.0001）与多变量分析中的总生存率相关。
在 NCCN 低危和中危前列腺癌的 1006 例连续患者队列中，LDR-PB 后 5 年和 10 年复发疾病的实际发生率约为 3%和 6%。
