Chad. G. Rusthoven, Bernard L. Jones, Thomas W. Flaig, E. David Crawford, Brian D. Kavanagh, and Thomas J. Pugh, University of Colorado School of Medicine, Aurora, CO; Matthew Koshy, University of Illinois at Chicago School of Medicine; Matthew Koshy, The University of Chicago School of Medicine, Chicago, IL; David J. Sher, University of Texas Southwestern, Dallas; Usama Mahmood and Brian F. Chapin University of Texas, MD Anderson Cancer Center, Houston, TX; and Ronald C. Chen University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Clin Oncol. 2016 Aug 20;34(24):2835-42. doi: 10.1200/JCO.2016.67.4788. Epub 2016 Jun 20.
There is growing interest in the role of local therapies, including external beam radiotherapy (RT), for men with metastatic prostate cancer (mPCa). We used the National Cancer Database (NCDB) to evaluate the overall survival (OS) of men with mPCa treated with androgen deprivation (ADT) with and without prostate RT.
The NCDB was queried for men with newly diagnosed mPCa, all treated with ADT, with complete datasets for RT, surgery, prostate-specific antigen (PSA) level, Gleason score, and Charlson-Deyo comorbidity score. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses.
From 2004 to 2012, 6,382 men with mPCa were identified, including 538 (8.4%) receiving prostate RT. At a median follow-up of 5.1 years, the addition of prostate RT to ADT was associated with improved OS on univariate (P < .001) and multivariate analysis (hazard ratio, 0.624; 95% CI, 0.551 to 0.706; P < .001) adjusted for age, year, race, comorbidity score, PSA level, Gleason score, T stage, N stage, chemotherapy administration, treating facility, and insurance status. Propensity score analysis with matched baseline characteristics demonstrated superior median (55 v 37 months) and 5-year OS (49% v 33%) with prostate RT plus ADT compared with ADT alone (P < .001). Landmark analyses limited to long-term survivors of ≥1, ≥3, and ≥5 years demonstrated improved OS with prostate RT in all subsets (all P < .05). Secondary analyses comparing the survival outcomes for patients treated with therapeutic dose RT plus ADT versus prostatectomy plus ADT during the same time interval demonstrated no significant differences in OS, whereas both therapies were superior to ADT alone.
In this large contemporary analysis, men with mPCa receiving prostate RT and ADT lived substantially longer than men treated with ADT alone. Prospective trials evaluating local therapies for mPCa are warranted.
局部治疗（包括外照射放疗）在转移性前列腺癌（mPCa）患者中的作用越来越受到关注。我们使用国家癌症数据库（NCDB）评估接受雄激素剥夺治疗（ADT）的 mPCa 男性患者接受和不接受前列腺放疗的总生存（OS）。
从 NCDB 中检索到 2004 年至 2012 年间诊断为 mPCa 的男性患者，所有患者均接受 ADT 治疗，且均有完整的放疗、手术、前列腺特异性抗原（PSA）水平、Gleason 评分和 Charlson-Deyo 合并症评分数据集。采用 Kaplan-Meier 法、对数秩检验、Cox 比例风险模型和倾向评分匹配分析来分析 OS。
从 2004 年至 2012 年，共确定了 6382 名 mPCa 患者，其中 538 名（8.4%）患者接受了前列腺放疗。在中位随访 5.1 年后，多变量分析（风险比，0.624；95%置信区间，0.551 至 0.706；P<0.001）显示，与 ADT 相比，ADT 联合前列腺放疗可显著改善 OS（单变量分析，P<0.001），且在校正年龄、年份、种族、合并症评分、PSA 水平、Gleason 评分、T 分期、N 分期、化疗、治疗机构和保险状况后，OS 仍有显著改善（P<0.001）。采用匹配基线特征的倾向评分分析显示，与单独 ADT 相比，ADT 联合前列腺放疗可显著提高中位（55 个月比 37 个月）和 5 年 OS（49%比 33%）（P<0.001）。在局限于≥1、≥3 和≥5 年的长期生存患者的亚组分析中，所有亚组均显示前列腺放疗可显著提高 OS（均 P<0.05）。对在同一时间间隔内接受治疗剂量 RT 联合 ADT 与前列腺切除术联合 ADT 治疗的患者的生存结果进行的二次分析显示，OS 无显著差异，而两种治疗方法均优于单独 ADT。
在这项大型的当代分析中，接受前列腺放疗和 ADT 治疗的 mPCa 男性患者的生存期明显长于单独接受 ADT 治疗的患者。有必要开展评价 mPCa 局部治疗的前瞻性试验。
