Department of Radiation Oncology, Hospital Ramón Y Cajal, Madrid, Spain.
Department of Radiation Oncology, Hospital Clínico Universitario, Santiago de Compostela, Spain.
Clin Transl Oncol. 2018 Feb;20(2):193-200. doi: 10.1007/s12094-017-1709-z. Epub 2017 Jun 30.
To compare adjuvant radiotherapy (ART) to salvage radiotherapy (SRT) after radical prostatectomy (RP) in a cohort of prostate cancer (PCa) patients. The primary aim was to comparatively assess 2- and 5-year biochemical relapse-free survival (BRFS). A secondary aim was to identify predictors of survival.
Data were acquired from the RECAP database, a population-based prostate cancer registry in Spain. Inclusion criteria included RP (with or without lymphadenectomy) followed by ART or SRT. A total of 702 patients were analyzed. Pre-RT PSA values (>0.5 vs. ≤0.5 ng/ml), pathological stage (T1-2 vs. T3-4), post-surgical Gleason score (≤7 vs. 8-10), margin status (positive vs. negative), hormonal treatment (yes vs. no), and RT dose (≤66 Gy vs. >66 Gy) were evaluated to assess their impact on BRFS.
The mean patient age in the ART and SRT groups, respectively, was 64 years (range 42-82) and 64.8 years (range 42-82). Median follow-up after RT in the whole sample was 34 months (range 3-141). A total of 702 patients were included: 223 (31.8%) received ART and 479 (68.2%) SRT. BRFS rates (95% CI) in the ART and SRT groups at months 24 and 60 were, respectively: 98.1% (95.9-100.0%) vs. 91.2% (88.2-94.2%) and 84.5% (76.4-92.6%) vs. 74.0% (67.4-80.7%) (p = 0.004). No significant differences in OS were observed (p = 0.053). The following variables were significant predictors of biochemical recurrence in the SRT group: (1) positive surgical margin status (p = 0.049); (2) no hormonotherapy (p = 0.03); (3) total prostate dose ≤66 Gy (p = 0.004); and pre-RT PSA ≥0.5 ng/ml (p = 0.013).
This is the first nationwide study in Spain to evaluate a large cohort of PCa patients treated with RP followed by postoperative RT. ART yielded better 2- and 5-year BRFS rates, although OS was equivalent. These findings are consistent with most other published studies and support ART in patients with adverse prognostic characteristics after radical prostatectomy. Prospective trials are needed to compare immediate ART to early SRT to better determine their relative benefits.
在前列腺癌（PCa）患者队列中比较辅助放疗（ART）与挽救性放疗（SRT）后的疗效。主要目的是比较评估 2 年和 5 年生化无复发生存率（BRFS）。次要目标是确定生存的预测因素。
数据来自西班牙基于人群的前列腺癌登记处 RECAP 数据库。纳入标准包括接受根治性前列腺切除术（RP）（伴或不伴淋巴结清扫术）后行 ART 或 SRT。共分析了 702 例患者。评估了治疗前 PSA 值（>0.5 vs. ≤0.5ng/ml）、病理分期（T1-2 vs. T3-4）、术后 Gleason 评分（≤7 vs. 8-10）、切缘状态（阳性 vs. 阴性）、激素治疗（是 vs. 否）和放疗剂量（≤66Gy vs. >66Gy），以评估其对 BRFS 的影响。
ART 和 SRT 组患者的平均年龄分别为 64 岁（范围 42-82 岁）和 64.8 岁（范围 42-82 岁）。全样本 RT 后中位随访时间为 34 个月（范围 3-141 个月）。共纳入 702 例患者：223 例（31.8%）接受 ART，479 例（68.2%）接受 SRT。ART 和 SRT 组在 24 个月和 60 个月时的 BRFS 率（95%CI）分别为：98.1%（95.9-100.0%）vs. 91.2%（88.2-94.2%）和 84.5%（76.4-92.6%）vs. 74.0%（67.4-80.7%）（p=0.004）。未观察到 OS 差异有统计学意义（p=0.053）。SRT 组中，以下变量是生化复发的显著预测因素：（1）阳性手术切缘状态（p=0.049）；（2）无激素治疗（p=0.03）；（3）总前列腺剂量≤66Gy（p=0.004）；（4）治疗前 PSA≥0.5ng/ml（p=0.013）。
这是西班牙首次对接受 RP 术后接受术后放疗的大量 PCa 患者进行评估的全国性研究。ART 产生了更好的 2 年和 5 年 BRFS 率，尽管 OS 相当。这些发现与大多数其他已发表的研究一致，并支持 ART 在根治性前列腺切除术后具有不良预后特征的患者中应用。需要前瞻性试验比较即刻 ART 与早期 SRT，以更好地确定它们的相对益处。
