Fu Alex Z, Tsai Huei-Ting, Haque Reina, Yood Marianne Ulcickas, Cassidy-Bushrow Andrea E, Van Den Eeden Stephen K, Keating Nancy L, Smith Matthew R, Zhou Yingjun, Aaronson David S, Potosky Arnold L
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C..
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.
J Urol. 2017 Jun;197(6):1448-1454. doi: 10.1016/j.juro.2016.12.086. Epub 2016 Dec 19.
Androgen deprivation therapy is often used as salvage treatment in men with rising prostate specific antigen after initial radical prostatectomy or radiotherapy for clinically localized prostate cancer. Given the lack of evidence from general practice, we examined the association of salvage androgen deprivation therapy with mortality in an observational cohort study.
From 3 managed care organizations we assembled a retrospective cohort of all 5,804 men with newly diagnosed localized prostate cancer from 1995 to 2009 who had a prostate specific antigen increase (biochemical recurrence) after primary radical prostatectomy or radiotherapy. The main outcomes were all-cause and prostate cancer specific mortality. We used Cox proportional hazards models to estimate mortality with salvage androgen deprivation therapy as a time dependent predictor.
Overall salvage androgen deprivation therapy was not associated with all-cause or prostate cancer specific mortality in the prostatectomy cohort (HR 0.97, 95% CI 0.70-1.35 or HR 1.18, 95% CI 0.68-2.07) or in the radiotherapy cohort (HR 0.84, 95% CI 0.70-1.01 or HR 1.06, 95% CI 0.80-1.40, respectively). Among men with prostate specific antigen doubling time less than 9 months after the prostate specific antigen rise, salvage androgen deprivation therapy was statistically significantly associated with a decreased risk of all-cause and prostate cancer specific mortality in the prostatectomy cohort (HR 0.35, 95% CI 0.20-0.63 and HR 0.43, 95% CI 0.21-0.91) and in the radiotherapy cohort (HR 0.62, 95% CI 0.48-0.80 and HR 0.65, 95% CI 0.47-0.90, respectively).
We found no association of salvage androgen deprivation therapy with all-cause or cause specific mortality in most men with biochemical recurrence after primary radical prostatectomy or radiotherapy for clinically localized prostate cancer. Men with quickly progressed disease may derive a clinical benefit from salvage androgen deprivation therapy.
对于临床局限性前列腺癌患者，在初次根治性前列腺切除术或放疗后前列腺特异性抗原升高时，雄激素剥夺疗法常被用作挽救性治疗。鉴于缺乏来自全科医疗的证据，我们在一项观察性队列研究中考察了挽救性雄激素剥夺疗法与死亡率之间的关联。
我们从3个管理式医疗组织中收集了1995年至2009年间所有5804例新诊断为局限性前列腺癌且在初次根治性前列腺切除术或放疗后出现前列腺特异性抗原升高（生化复发）的男性患者，组成一个回顾性队列。主要结局为全因死亡率和前列腺癌特异性死亡率。我们使用Cox比例风险模型，将挽救性雄激素剥夺疗法作为时间依赖性预测因素来估计死亡率。
总体而言，在前列腺切除队列（风险比0.97，95%置信区间0.70 - 1.35或风险比1.18，95%置信区间0.68 - 2.07）或放疗队列（分别为风险比0.84，95%置信区间0.70 - 1.01或风险比1.06，95%置信区间0.80 - 1.40）中，挽救性雄激素剥夺疗法与全因死亡率或前列腺癌特异性死亡率均无关联。在前列腺特异性抗原升高后前列腺特异性抗原倍增时间小于9个月的男性中，在前列腺切除队列（风险比0.35，95%置信区间0.20 - 0.63和风险比0.43，95%置信区间0.21 - 0.91）和放疗队列（分别为风险比0.62，95%置信区间0.48 - 0.80和风险比0.65，95%置信区间0.47 - 0.90）中，挽救性雄激素剥夺疗法与全因死亡率和前列腺癌特异性死亡率降低的风险在统计学上显著相关。
我们发现，对于大多数临床局限性前列腺癌患者在初次根治性前列腺切除术或放疗后出现生化复发的情况，挽救性雄激素剥夺疗法与全因死亡率或病因特异性死亡率均无关联。疾病进展迅速的男性患者可能从挽救性雄激素剥夺疗法中获得临床益处。
