Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Eur Urol. 2015 Jan;67(1):3-6. doi: 10.1016/j.eururo.2014.08.056. Epub 2014 Sep 10.
A recent study observed a survival benefit in men diagnosed with metastatic prostate cancer (mPCa) and managed with local treatment of the primary tumor (LT; either radical prostatectomy plus pelvic lymph node dissection or radiation therapy). We tested the hypothesis that only specific mPCa patients would benefit from LT and that the potential benefit would vary based on primary tumor characteristics. A total of 8197 mPCa patients at diagnosis (M1a, M1b, and M1c) were identified using the Surveillance Epidemiology and End Results database (2004-2011) and were divided according to treatment type: LT versus nonlocal treatment of the primary tumor (NLT; either androgen deprivation therapy or observation). Multivariable Cox regression analysis was used to predict cancer-specific mortality (CSM) in patients that received NLT. To assess whether the benefit of LT was different by baseline risk, we tested an interaction with CSM risk and LT. At multivariable analysis, all predictors were significantly associated with CSM, and the interaction test was statistically significant (p<0.0001). Local treatment of the primary tumor, compared with NLT, conferred a higher CSM-free survival rate in patients with a predicted CSM risk <40%. The number needed to treat according to the predicted CSM risk at 3 yr after diagnosis remained substantially constant from 10% to 30%, whereas it exponentially increased for predicted CSM risk >40%. These results should serve as a foundation for future prospective trials.
Among metastatic prostate cancer patients, the potential benefit of local treatment to the primary tumor depends greatly on tumor characteristics, and patient selection is essential to avoid either over- or undertreatment.
最近的一项研究观察到，接受局部原发肿瘤治疗（LT；根治性前列腺切除术加盆腔淋巴结清扫术或放疗）的转移性前列腺癌（mPCa）男性患者的生存获益。我们检验了以下假说：只有特定的 mPCa 患者会从 LT 中受益，并且潜在的获益将根据原发肿瘤特征而有所不同。使用 Surveillance, Epidemiology, and End Results（SEER）数据库（2004-2011 年）共确定了 8197 例 mPCa 患者（M1a、M1b 和 M1c），并根据治疗方式进行了分组：LT 与原发肿瘤的非局部治疗（NLT；雄激素剥夺治疗或观察）。采用多变量 Cox 回归分析预测接受 NLT 的患者的癌症特异性死亡率（CSM）。为了评估 LT 的获益是否因基线风险而异，我们对 CSM 风险与 LT 之间的交互作用进行了检验。多变量分析显示，所有预测因素均与 CSM 显著相关，且交互检验具有统计学意义（p<0.0001）。与 NLT 相比，LT 可使预测 CSM 风险<40%的患者获得更高的 CSM 无复发生存率。根据诊断后 3 年的预测 CSM 风险，治疗人数需要根据预测 CSM 风险从 10%到 30%保持基本不变，而对于预测 CSM 风险>40%的患者则呈指数级增加。这些结果应该为未来的前瞻性试验奠定基础。
在转移性前列腺癌患者中，局部原发肿瘤治疗的潜在获益在很大程度上取决于肿瘤特征，患者选择对于避免过度或不足治疗至关重要。
