American Cancer Society, 250 Williams Street NW, Atlanta, GA, USA.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
Eur Urol. 2015 Nov;68(5):768-74. doi: 10.1016/j.eururo.2015.04.003. Epub 2015 Apr 18.
Patterns of postoperative radiotherapy (RT) use in prostate cancer (PCa) after the publication of major randomized trials have not been well characterized.
To describe patterns of postoperative RT use after radical prostatectomy (RP) in patients with adverse pathologic features in the United States.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 97 270 patients with PCa diagnosed between 2005 and 2011 whose presentation and outcomes were recorded in the National Cancer Data Base.
Temporal changes in receipt of postoperative RT and factors associated with receipt of this treatment using the Cochran-Armitage trend test and multiple logistic regression, respectively.
Between 2005 and 2011, receipt of postoperative RT decreased steadily from 9.1% to 7.3% (ptrend<0.001). Use of RT with or without androgen deprivation therapy monotonically decreased with advancing age from 8.5% in patients aged 18-59 yr to 6.8% in patients aged 70-79 yr (ptrend<0.001). Receipt of RT was higher at community cancer programs compared with teaching/research centers (14% vs 7.3%; odds ratio [OR]: 2.16; p<0.001), in those with pT3-4 disease and positive margins compared with those with pT3-4 and negative margins (17% vs 5.9%; OR: 2.89; p<0.001), and in patients with a Gleason score of 8-10 compared with those with a Gleason score of 2-6 (17% vs 4.2%; OR: 3.50; p<0.001). Limitations include lack of postprostatectomy prostate-specific antigen level.
Postoperative RT use for localized PCa in patients with adverse pathologic features is declining in the United States.
In this report, we show that use of postoperative radiotherapy in patients with prostate cancer with adverse pathologic features is declining. Patients treated at community cancer programs, those with locally advanced disease and positive margins, and those with a high Gleason score were more likely to receive postoperative radiotherapy.
在主要随机试验发表后，前列腺癌（PCa）术后放疗（RT）的应用模式尚未得到很好的描述。
描述美国根治性前列腺切除术（RP）后具有不良病理特征的 PCa 患者术后 RT 的应用模式。
设计、地点和参与者：回顾性分析 2005 年至 2011 年间在国家癌症数据库中记录了 PCa 表现和结局的 97270 例患者。
使用 Cochran-Armitage 趋势检验和多因素逻辑回归分别评估术后 RT 接受情况的时间变化以及与接受这种治疗相关的因素。
2005 年至 2011 年间，术后 RT 的使用率从 9.1%稳步下降至 7.3%（ptrend<0.001）。接受 RT 联合或不联合雄激素剥夺治疗的患者比例随着年龄的增长而单调下降，从 18-59 岁的患者的 8.5%降至 70-79 岁的患者的 6.8%（ptrend<0.001）。社区癌症项目中 RT 的使用率高于教学/研究中心（14%比 7.3%；比值比[OR]：2.16；p<0.001），pT3-4 期疾病伴阳性切缘的患者高于 pT3-4 期且切缘阴性的患者（17%比 5.9%；OR：2.89；p<0.001），Gleason 评分 8-10 的患者高于 Gleason 评分 2-6 的患者（17%比 4.2%；OR：3.50；p<0.001）。局限性包括缺乏前列腺特异性抗原水平的检测。
美国具有不良病理特征的局限性 PCa 患者术后 RT 的应用正在减少。
在这项报告中，我们表明，具有不良病理特征的前列腺癌患者术后放疗的应用正在减少。在社区癌症项目中接受治疗的患者、局部进展性疾病伴阳性切缘的患者以及 Gleason 评分较高的患者更有可能接受术后放疗。
