Jackson Matthew W, Amini Arya, Jones Bernard L, Kavanagh Brian, Maroni Paul, Frank Steven J, Mahmood Usama, Kudchadker Rajat J, Pugh Thomas J
Department of Radiation Oncology, The University of Colorado Hospital, Aurora, CO.
Department of Urology, The University of Colorado Hospital, Aurora, CO.
Brachytherapy. 2017 Jul-Aug;16(4):790-796. doi: 10.1016/j.brachy.2017.03.007. Epub 2017 Apr 23.
Conventional prostate cancer risk stratification results in considerable heterogeneity within each prognostic group. Men with pathologic grade Group 4 (Gleason score 8) but otherwise low-risk features have been identified as a favorable subset of high-risk prostate cancer. Given recent randomized data supporting improved cancer outcome with brachytherapy in intermediate- and high-risk prostate cancer, we sought to evaluate brachytherapy utilization and overall survival (OS) for these patients.
We queried the National Cancer Database for clinical T1c-T2a N0 M0 prostate cancer with prostate-specific antigen <10 ng/mL and Gleason score 8 adenocarcinoma on biopsy. All patients received androgen deprivation therapy and either external beam radiation therapy (EBRT) alone, brachytherapy alone, or a combination of EBRT with brachytherapy boost (brachytherapy + EBRT). Kaplan-Meier OS estimates as well as univariate and multivariate Cox proportional hazards regression analyses were performed. Propensity score-matched analyses were performed to further control for baseline confounders.
Four thousand four hundred ninety-six patients were identified with a median followup of 62.5 months (range, 2.3-119.8). Median age was 72 years (range, 41-90+). Utilization of brachytherapy decreased from 2004 to 2009. The odds ratio for brachytherapy by year (continuous variable) was 0.86 (p < 0.001). Five-year OS was 84%, 88%, and 89% for the EBRT alone, brachytherapy alone, and brachytherapy + EBRT groups, respectively. On multivariate analysis, higher median income, low comorbidity score, and treatment with brachytherapy alone (hazard ratio, 0.66; p = 0.005) or brachytherapy + EBRT (hazard ratio, 0.70; p = 0.001) remained associated with longer OS. Propensity score matching confirmed longer OS associated with either brachytherapy regimen.
Of those men with World Health Organization pathologic grade Group 4 (Gleason score 8) prostate cancer and otherwise favorable prognostic features treated with androgen deprivation therapy and radiation therapy, longer OS was achieved when prostate brachytherapy was included, whether used alone or in combination with supplemental EBRT. In spite of these excellent outcomes, prostate brachytherapy utilization is declining in the United States.
传统的前列腺癌风险分层在每个预后组内导致相当大的异质性。病理分级为4级（ Gleason评分8分）但其他方面具有低风险特征的男性已被确定为高危前列腺癌的一个有利亚组。鉴于最近的随机数据支持近距离放射治疗可改善中高危前列腺癌的癌症结局，我们试图评估这些患者的近距离放射治疗利用率和总生存期（OS）。
我们查询了国家癌症数据库，以获取临床分期为T1c-T2a N0 M0、前列腺特异性抗原<10 ng/mL且活检为Gleason评分8分腺癌的前列腺癌患者。所有患者均接受雄激素剥夺治疗，并单独接受外照射放疗（EBRT）、单独接受近距离放射治疗或EBRT联合近距离放射治疗加强（近距离放射治疗+EBRT）。进行了Kaplan-Meier OS估计以及单因素和多因素Cox比例风险回归分析。进行倾向评分匹配分析以进一步控制基线混杂因素。
共识别出4496例患者，中位随访时间为62.5个月（范围2.3-119.8个月）。中位年龄为72岁（范围41-90+岁）。2004年至2009年期间，近距离放射治疗的使用率下降。按年份（连续变量）计算的近距离放射治疗优势比为0.86（p<0.001）。单独EBRT组、单独近距离放射治疗组和近距离放射治疗+EBRT组的5年总生存率分别为84%、88%和89%。多因素分析显示，较高的中位收入、低合并症评分以及单独接受近距离放射治疗（风险比，0.66；p=0.005）或近距离放射治疗+EBRT（风险比，0.70；p=0.001）与更长的总生存期相关。倾向评分匹配证实两种近距离放射治疗方案均与更长的总生存期相关。
在接受雄激素剥夺治疗和放射治疗的世界卫生组织病理分级为4级（Gleason评分8分）前列腺癌且其他预后特征良好的男性中，无论单独使用还是与补充EBRT联合使用，纳入前列腺近距离放射治疗时均可实现更长的总生存期。尽管有这些出色的结果，但美国前列腺近距离放射治疗的使用率正在下降。
