Degroot Julie M, Brundage Michael D, Lam Miu, Rohland Susan L, Heaton Jeremy, Mackillop William J, Siemens D Robert, Groome Patti A
Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON;
Can Urol Assoc J. 2013 May-Jun;7(5-6):E299-305. doi: 10.5489/cuaj.11294. Epub 2013 May 13.
We compared the cause-specific survival of patients who received radiotherapy to those who received surgery for cure of their prostate cancer using a number of design and analytic steps to mitigate confounding by indication.
This was a case-cohort study of 2213 patients in the Ontario Cancer Registry diagnosed between 1990 and 1998 who were either treatment candidates or received curative radiotherapy or surgery. Cases included patients who died of prostate cancer within 10 years. The study population was restricted to those who were candidates for either treatment (radiotherapy or surgery) based on disease severity (low and intermediate risk using the Genitourinary Radiation Oncologists of Canada risk groups). The median follow-up was 51 months. Cause-specific survival was analyzed using Cox-proportional hazards regression with case-cohort variance adjustment. Results from intent-to-treat analyses were compared to results by treatment received.
Adjusted hazard ratios for risk of prostate cancer death for radiotherapy compared to surgery for the entire study population were 1.62 (95%CI 1.00-2.61) and 2.02 (1.19-3.43) analyzing by intent-to-treat and treatment received, respectively. Intent-to-treat hazard ratios for the low- and intermediate-risk groups were 0.87 (0.28-2.76) and 1.57 (0.95-2.61), respectively.
Overall results were driven by the finding in the intermediate-risk group, which indicated that radiotherapy was not as effective as surgery in this group. Confirmation was needed with special attention paid to risk stratification and the impact of more contemporary delivery of these treatment options.
我们采用了一系列设计和分析步骤，以减轻指征性混杂因素的影响，比较了接受放射治疗和接受手术治疗以治愈前列腺癌的患者的特定病因生存率。
这是一项对安大略癌症登记处1990年至1998年间诊断出的2213例患者进行的病例队列研究，这些患者均为治疗候选者或接受了根治性放射治疗或手术。病例包括在10年内死于前列腺癌的患者。研究人群仅限于那些根据疾病严重程度（使用加拿大泌尿生殖放射肿瘤学家风险组的低风险和中风险）适合接受任何一种治疗（放射治疗或手术）的患者。中位随访时间为51个月。使用Cox比例风险回归和病例队列方差调整分析特定病因生存率。将意向性分析的结果与接受治疗后的结果进行比较。
在整个研究人群中，按意向性分析和接受治疗分析，放射治疗与手术相比，前列腺癌死亡风险的调整后风险比分别为1.62（95%CI 1.00 - 2.61）和2.02（1.19 - 3.43）。低风险和中风险组的意向性风险比分别为0.87（0.28 - 2.76）和1.57（0.95 - 2.61）。
总体结果受中风险组结果的驱动，这表明放射治疗在该组中不如手术有效。需要进一步证实，特别要注意风险分层以及这些治疗方案更现代应用的影响。
