Parikh Rahul R, Byun John, Goyal Sharad, Kim Isaac Yi
Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, New Jersey.
Rutgers Cancer Institute of New Jersey, Department of Urology, New Brunswick, New Jersey.
Prostate. 2017 May;77(6):559-572. doi: 10.1002/pros.23294. Epub 2017 Jan 17.
The role of local therapy, in the form of radiation therapy (RT) or radical prostatectomy(RP), and its association on outcomes is not well established in patients with metastatic prostate cancer.
Using the National Cancer Database (NCDB), we evaluated patterns of care and outcomes among patients diagnosed with metastatic prostate cancer from 2004 to 2013 treated with local therapy (RP, intensity-modulated radiation therapy [IMRT], or 2D/3D-conformal radiation therapy [CRT]). The association between local therapy, co-variates, and outcomes was assessed in a multivariable Cox proportional hazards model and Propensity score (PS) matching was performed to balance confounding factors. Survival was estimated using the Kaplan-Meier method.
Among the 1,208,180 patients in the NCDB with prostate cancer, 6,051 patients met the inclusion criteria. No local therapy was used in 5,224 patients, while 622 (10.3%), 52 (0.9%), 153 (2.5%) patients received RP, IMRT, and 2D/3D-CRT, respectively. Use of local therapy was associated with younger age (≤70), lower co-morbidity score, lower T-stage, Gleason score <8, node-negative status, private, and Medicare insurance, higher income quartile, and treatment at comprehensive or academic/research programs (P < 0.05). Five-year overall survival for patients receiving local therapy was 45.7% versus 17.1% for those not receiving local therapy (P < 0.01). In multivariate analysis, RP (HR = 0.51; 95%CI, 0.45-0.59, P < 0.01) and IMRT (HR = 0.47; 95%CI, 0.31-0.72, P < 0.01) were independently associated with superior overall survival. After PS-matching, the use of local therapy (RP or IMRT) remained significantly associated with overall survival (HR = 0.35; 95%CI, 0.30-0.41, P < 0.01).
The use of RP and IMRT, to treat the primary disease, was associated with improvements in overall survival for patients with metastatic prostate cancer. We have identified patient-specific variations in the use of local therapy that may be tested in subsequent prospective clinical trials to improve patient outcomes in this setting. Prostate 77: 559-572, 2017. © 2017 Wiley Periodicals, Inc.
对于转移性前列腺癌患者，以放射治疗（RT）或根治性前列腺切除术（RP）形式的局部治疗的作用及其与预后的关联尚未完全明确。
利用国家癌症数据库（NCDB），我们评估了2004年至2013年期间接受局部治疗（RP、调强放射治疗[IMRT]或二维/三维适形放射治疗[CRT]）的转移性前列腺癌患者的治疗模式和预后。在多变量Cox比例风险模型中评估局部治疗、协变量与预后之间的关联，并进行倾向评分（PS）匹配以平衡混杂因素。使用Kaplan-Meier方法估计生存率。
在NCDB中1,208,180例前列腺癌患者中，6,051例符合纳入标准。5,224例患者未接受局部治疗，而分别有622例（10.3%）、52例（0.9%）、153例（2.5%）患者接受了RP、IMRT和二维/三维CRT。局部治疗的使用与较年轻年龄（≤70岁）、较低的合并症评分、较低的T分期、Gleason评分<8、淋巴结阴性状态、私立和医疗保险、较高的收入四分位数以及在综合或学术/研究机构接受治疗相关（P<0.05）。接受局部治疗患者的五年总生存率为45.7%，未接受局部治疗患者为17.1%（P<0.01）。在多变量分析中，RP（HR=0.51；95%CI，0.45-0.59，P<0.01）和IMRT（HR=0.47；95%CI，0.31-0.72，P<0.01）与较好的总生存率独立相关。PS匹配后，局部治疗（RP或IMRT）的使用仍与总生存率显著相关（HR=0.35；95%CI，0.30-0.41，P<0.01）。
使用RP和IMRT治疗原发性疾病与转移性前列腺癌患者总生存率的改善相关。我们已经确定了局部治疗使用方面患者特异性的差异，这些差异可在后续前瞻性临床试验中进行检验，以改善该情况下患者的预后。《前列腺》77：559-572，2017。©2017威利期刊公司。
