Marsh Sydney, Walters Ryan W, Silberstein Peter T
Creighton University School of Medicine, Omaha, NE.
Creighton University School of Medicine, Omaha, NE.
Clin Genitourin Cancer. 2017 Aug 9. doi: 10.1016/j.clgc.2017.07.029.
Studies of various prostate cancer patient cohorts found men receiving external-beam radiotherapy (EBRT) had higher mortality than men undergoing radical prostatectomy (RP). Conversely, a recent clinical trial showed no survival differences between treatment groups. We used the National Cancer Data Base (NCDB) to evaluate overall survival in intermediate-risk (T2b-T2c or Gleason 7 [grade group II or III] or prostate-specific antigen 10-20 ng/mL) prostate cancer patients undergoing EBRT with or without androgen deprivation therapy (ADT), RP, or no initial treatment.
We analyzed 268,378 men with intermediate-risk prostate cancer from 2004 to 2012. Kaplan-Meier estimates and multivariable Cox proportional hazards models were used to compare survival between treatments.
After adjusting for patient and facility covariables, men receiving no initial treatment averaged greater adjusted mortality risk than men receiving EBRT (hazard ratio [HR], 1.71; 95% confidence interval [CI] 1.62-1.80; P < .001), EBRT + ADT (HR, 1.73; 95% CI 1.64-1.81; P < .001), or RP (HR, 4.18; 95% CI 3.94-4.43; P < .001). Men undergoing RP had significantly lower adjusted mortality risk than men receiving either EBRT (HR, 0.41; 95% CI 0.39-0.43; P < .001) or EBRT + ADT (HR, 0.41; 95% CI 0.39-0.43; P < .001). No difference was observed between men receiving EBRT or EBRT + ADT (HR, 1.01; 95% CI 0.97-1.05; P = .624).
Men treated with RP experienced significantly lower overall mortality risk than EBRT with or without ADT and no treatment patients, regardless of patient, demographic, or facility characteristics. The results are limited by the lack of cancer-specific mortality in this database.
对不同前列腺癌患者队列的研究发现，接受外照射放疗（EBRT）的男性比接受根治性前列腺切除术（RP）的男性死亡率更高。相反，最近的一项临床试验显示治疗组之间无生存差异。我们使用国家癌症数据库（NCDB）来评估接受EBRT联合或不联合雄激素剥夺治疗（ADT）、RP或未进行初始治疗的中危（T2b - T2c或Gleason 7[分级组II或III]或前列腺特异性抗原10 - 20 ng/mL）前列腺癌患者的总生存率。
我们分析了2004年至2012年期间268378例中危前列腺癌男性患者。采用Kaplan - Meier估计法和多变量Cox比例风险模型比较不同治疗方法之间的生存率。
在对患者和机构协变量进行调整后，未进行初始治疗的男性患者的调整后死亡风险平均高于接受EBRT的男性（风险比[HR]，1.71；95%置信区间[CI] 1.62 - 1.80；P <.001）、EBRT + ADT的男性（HR，1.73；95% CI 1.64 - 1.81；P <.001）或RP的男性（HR，4.18；95% CI 3.94 - 4.43；P <.001）。接受RP的男性患者的调整后死亡风险显著低于接受EBRT（HR，0.41；95% CI 0.39 - 0.43；P <.001）或EBRT + ADT的男性（HR，0.41；95% CI 0.39 - 0.43；P <.001）。接受EBRT或EBRT + ADT的男性之间未观察到差异（HR，1.01；95% CI 0.97 - 1.05；P =.624）。
无论患者、人口统计学或机构特征如何，接受RP治疗的男性总体死亡风险显著低于接受EBRT联合或不联合ADT以及未接受治疗的患者。本数据库缺乏癌症特异性死亡率，因此结果受到一定限制。
