对于前列腺癌根治术后病理证实有淋巴结受累的男性患者，辅助放疗联合激素治疗可提高生存率。

Adjuvant radiation with hormonal therapy is associated with improved survival in men with pathologically involved lymph nodes after radical surgery for prostate cancer.

作者信息

Wong Andrew T, Schwartz David, Osborn Virginia, Safdieh Joseph, Weiner Joseph, Schreiber David

机构信息

Department of Radiation Oncology, Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY.

出版信息

Urol Oncol. 2016 Dec;34(12):529.e15-529.e20. doi: 10.1016/j.urolonc.2016.06.017. Epub 2016 Jul 18.

DOI:10.1016/j.urolonc.2016.06.017

PMID:27443637

Abstract

PURPOSE

Recent studies have suggested that the addition of adjuvant radiation therapy (aRT) may improve outcomes in men with pathologically involved lymph nodes (pN+). The objective of this study was to assess the treatment patterns and the overall survival (OS) outcomes in men with pN+prostate cancer using the National Cancer Data Base.

METHODS

Men diagnosed with nonmetastatic prostate cancer between 2004 and 2011, who underwent radical prostatectomy for pN+were identified in the National Cancer Data Base. Patients were stratified into subgroups of those receiving no adjuvant therapy and those receiving adjuvant hormonal therapy (aHT) alone, aRT alone, and aRT+aHT. OS was analyzed using Kaplan-Meier method and compared between the groups using the log-rank test. Multivariable Cox regression was used to identify covariates that affected OS.

RESULTS

A total of 7,225 patients were included in this analysis, of whom 3,636 (50.3%) received no adjuvant therapy, 2,041 (28.2%) received aHT alone, 350 (4.8%) received aRT alone, and 1,198 (16.5%) received aRT+aHT. The 5-year OS rates were 85.2% for no adjuvant therapy, 82.9% for aHT alone, 88.3% for aRT alone, and 88.8% for combination hormonal therapy, i.e., aRT+aHT (P<0.001). On multivariable analysis, aRT+aHT was associated with a significantly decreased risk of death (hazard ratio [HR] = 0.67; 95% CI: 0.54-0.83; P<0.001) compared with no adjuvant therapy, whereas aHT alone (HR = 0.99; 95% CI: 0.85-1.15; P = 0.90) and aRT alone (HR = 1.02; 95% CI: 0.74-1.40; P = 0.92) were not.

CONCLUSION

Patients treated with multimodal aRT+aHT had significantly higher OS rate than patients treated without adjuvant therapy or with aHT/aRT alone.

摘要

目的

近期研究表明，辅助放疗（aRT）的加入可能改善病理淋巴结受累（pN+）男性患者的预后。本研究的目的是利用国家癌症数据库评估pN+前列腺癌男性患者的治疗模式和总生存（OS）结局。

方法

在国家癌症数据库中识别出2004年至2011年间被诊断为非转移性前列腺癌且因pN+接受根治性前列腺切除术的男性患者。患者被分层为未接受辅助治疗、仅接受辅助激素治疗（aHT）、仅接受aRT以及接受aRT+aHT的亚组。使用Kaplan-Meier方法分析OS，并使用对数秩检验在组间进行比较。多变量Cox回归用于识别影响OS的协变量。

结果

本分析共纳入7225例患者，其中3636例（50.3%）未接受辅助治疗，2041例（28.2%）仅接受aHT，350例（4.8%）仅接受aRT，1198例（16.5%）接受aRT+aHT。未接受辅助治疗的5年OS率为85.2%，仅接受aHT的为82.9%，仅接受aRT的为88.3%，联合激素治疗即aRT+aHT的为88.8%（P<0.001）。多变量分析显示，与未接受辅助治疗相比，aRT+aHT与死亡风险显著降低相关（风险比[HR]=0.67；95%可信区间：0.54-0.83；P<0.001），而仅接受aHT（HR=0.99；95%可信区间：0.85-1.15；P=0.90）和仅接受aRT（HR=1.02；95%可信区间：0.74-1.40；P=0.92）则不然。