Muralidhar Vinayak, Chen Ming-Hui, Reznor Gally, Moran Brian J, Braccioforte Michelle H, Beard Clair J, Feng Felix Y, Hoffman Karen E, Choueiri Toni K, Martin Neil E, Sweeney Christopher J, Trinh Quoc-Dien, Nguyen Paul L
Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts.
Department of Statistics, University of Connecticut, Storrs, Connecticut.
Int J Radiat Oncol Biol Phys. 2015 Nov 15;93(4):828-35. doi: 10.1016/j.ijrobp.2015.07.2281. Epub 2015 Jul 29.
To define and validate a classification of favorable high-risk prostate cancer that could be used to personalize therapy, given that consensus guidelines recommend similar treatments for all radiation-managed patients with high-risk disease.
We studied 3618 patients with cT1-T3aN0M0 high-risk or unfavorable intermediate-risk prostate adenocarcinoma treated with radiation at a single institution between 1997 and 2013. Favorable high-risk was defined as T1c disease with either Gleason 4 + 4 = 8 and prostate-specific antigen <10 ng/mL or Gleason 6 and prostate-specific antigen >20 ng/mL. Competing risks regression was used to determine differences in the risk of prostate cancer-specific mortality (PCSM) after controlling for baseline factors and treatment. Our results were validated in a cohort of 13,275 patients using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.
Patients with favorable high-risk disease had significantly better PCSM than other men with high-risk disease (adjusted hazard ratio [AHR] 0.42, 95% confidence interval [CI] 0.18-0.996, P=.049) and similar PCSM as men with unfavorable intermediate-risk disease (AHR 1.17, 95% CI 0.50-2.75, P=.710). We observed very similar results within the SEER-Medicare cohort (favorable high-risk vs other high-risk: AHR 0.21, 95% CI 0.11-0.41, P<.001; favorable high-risk vs unfavorable intermediate-risk: AHR 0.67, 95% CI 0.33-1.36, P=.268).
Patients with favorable high-risk prostate cancer have significantly better PCSM than other patients with high-risk disease and similar PCSM as those with unfavorable intermediate-risk disease, who are typically treated with shorter-course androgen deprivation therapy. This new classification system may allow for personalization of treatment within high-risk disease, such as consideration of shorter-course androgen deprivation therapy for favorable high-risk disease.
鉴于共识指南建议对所有接受放疗的高危疾病患者采用相似的治疗方法，本研究旨在定义并验证一种可用于个性化治疗的有利高危前列腺癌分类。
我们研究了1997年至2013年间在单一机构接受放疗的3618例cT1-T3aN0M0高危或不良中危前列腺腺癌患者。有利高危定义为T1c疾病，Gleason评分4 + 4 = 8且前列腺特异性抗原<10 ng/mL，或Gleason评分6且前列腺特异性抗原>20 ng/mL。在控制基线因素和治疗后，采用竞争风险回归分析来确定前列腺癌特异性死亡率（PCSM）的差异。我们的研究结果在一个由13275例患者组成的队列中，使用监测、流行病学和最终结果（SEER）-医疗保险链接数据库进行了验证。
有利高危疾病患者的PCSM显著优于其他高危疾病男性患者（调整后风险比[AHR] 0.42，95%置信区间[CI] 0.18 - 0.996，P = 0.049），且与不良中危疾病男性患者的PCSM相似（AHR 1.17，95% CI 0.50 - 2.75，P = 0.710）。在SEER-医疗保险队列中，我们观察到了非常相似的结果（有利高危与其他高危：AHR 0.21，95% CI 0.11 - 0.41，P < 0.001；有利高危与不良中危：AHR 0.67，95% CI 0.33 - 1.36，P = 0.268）。
有利高危前列腺癌患者的PCSM显著优于其他高危疾病患者，且与通常接受短疗程雄激素剥夺治疗的不良中危疾病患者的PCSM相似。这种新的分类系统可能有助于在高危疾病中实现个性化治疗，例如考虑对有利高危疾病采用短疗程雄激素剥夺治疗。
