Delouya Guila, Lambert Carole, Bahary Jean-Paul, Beauchemin Marie-Claude, Barkati Maroie, Ménard Cynthia, Taussky Daniel
Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Québec, Canada.
Can J Urol. 2017 Jun;24(3):8822-8826.
We tested different classification systems in order to separate intermediate-risk prostate cancers into prognostic groups. We then examined which groups were most suited for either prostate seed brachytherapy (PB) or external beam radiotherapy (EBRT).
We selected patients with D'Amico intermediate-risk prostate cancer who were treated exclusively with either PB or EBRT. Patients were excluded if they had received androgen deprivation therapy in combination with EBRT or a follow up of < 30 months without recurrence. The Kaplan-Meier method was used to compare groups.
Our sample consisted of 475 patients treated from July 2002-September 2013. Median follow up for patients without biochemical failure (BF) was 56 months (interquartile range 44-78); 222 patients (47%) were treated with PB exclusively (D90 interquartile range 145-176 Gy) and 253 (53%) with EBRT exclusively (dose interquartile range 76-80 Gy). The rate of BF was significantly lower in patients treated with PB (5.4%) than in patients treated with EBRT (14.2%) (p = 0.036, log-rank test). Upon univariate analysis, significant predictors of BF included the number of unfavorable intermediate-risk factors (0, 1, 2, 3) (p = 0.024) as well as the Cancer of the Prostate Risk Assessment (CAPRA) score (p = 0.002). After adjusting for the type of treatment, only the CAPRA score remained predictive (p = 0.025). For patients with a CAPRA score of 0-2, those with PB fared better than those treated with EBRT (p = 0.042). This difference disappeared in patients with a CAPRA score of 3-5 (p = 0.5).
Using our current selection criteria for monotherapy, we found that PB or EBRT as monotherapy are equally effective treatment options for intermediate-risk prostate cancer.
我们测试了不同的分类系统，以便将中危前列腺癌患者分为不同的预后组。然后，我们研究了哪些组最适合前列腺粒子近距离放疗（PB）或外照射放疗（EBRT）。
我们选择了仅接受PB或EBRT治疗的D'Amico中危前列腺癌患者。如果患者接受了雄激素剥夺疗法联合EBRT治疗，或随访时间少于30个月且无复发，则将其排除。采用Kaplan-Meier方法比较各组。
我们的样本包括2002年7月至2013年9月期间治疗的475例患者。无生化复发（BF）患者的中位随访时间为56个月（四分位间距44-78个月）；222例患者（47%）仅接受PB治疗（D90四分位间距145-176 Gy），253例患者（53%）仅接受EBRT治疗（剂量四分位间距76-80 Gy）。接受PB治疗的患者BF发生率（5.4%）显著低于接受EBRT治疗的患者（14.2%）（p = 0.036，对数秩检验）。单因素分析显示，BF的显著预测因素包括不利中危因素的数量（0、1、2、3）（p = 0.024）以及前列腺癌风险评估（CAPRA）评分（p = 0.002）。在调整治疗类型后，只有CAPRA评分仍具有预测性（p = 0.025）。对于CAPRA评分为0-2分的患者，接受PB治疗的患者比接受EBRT治疗的患者预后更好（p = 0.042）。这种差异在CAPRA评分为3-5分的患者中消失（p = 0.5）。
根据我们目前的单药治疗选择标准，我们发现PB或EBRT作为单药治疗是中危前列腺癌同样有效的治疗选择。
