中危前列腺癌的近距离放射治疗、雄激素剥夺与死亡风险

Brachytherapy for Intermediate-Risk Prostate Cancer, Androgen Deprivation, and the Risk of Death.

作者信息

Pickles Tom, Tyldesley Scott, Hamm Jeremy, Virani Sean A, Morris W James, Keyes Mira

机构信息

Radiation Program, BC Cancer Agency, Vancouver, British Columbia, Canada; Department of Radiotherapy and Developmental Radiotherapeutics, University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

Int J Radiat Oncol Biol Phys. 2018 Jan 1;100(1):45-52. doi: 10.1016/j.ijrobp.2017.08.042. Epub 2017 Sep 4.

DOI:10.1016/j.ijrobp.2017.08.042

PMID:29029889

Abstract

PURPOSE

To determine whether the use of 6 months' adjuvant androgen deprivation therapy (ADT) combined with brachytherapy for intermediate-risk (IR) and low-risk (LR) prostate cancer is associated with an increased risk of cardiovascular death.

METHODS AND MATERIALS

This is a retrospective analysis of prospectively collected data from men treated in the British Columbia Cancer Agency brachytherapy program from 1998 to 2012. Men were categorized by risk group and ADT use. Cardiac and other comorbidities were recorded and compared between groups. Biochemical control (Phoenix definition, nadir + 2 ng/mL) was ascertained. Overall, prostate, cardiac, and other-cause mortality were analyzed by the Kaplan-Meier method and Fine and Gray competing-risk analysis.

RESULTS

The study included 3155 men (1142 with LR cancer and 2013 with IR cancer) who have been followed up for a median of 7.9 years. ADT was received by 47% of IR patients and 37% of LR patients for a median of 6 months. Men with IR cancer were older and had more cardiac and other comorbidities than LR cases (P<.01). Biochemical control improved from 86% to 89% at 10 years with the use of ADT (P=.006). Overall survival was inferior in patients receiving ADT (84% vs 86% at 10 years, P=.0274), and on competing-risk analysis, cardiovascular mortality in patients receiving ADT was higher in IR cases, 5.2% versus 3.6% at 10 years (P=.0493), but not in LR cases. Multivariate analysis confirmed increased cardiac mortality in IR patients receiving ADT (hazard ratio, 1.95 [95% confidence interval, 1.15-3.34]; P=.014).

CONCLUSIONS

ADT adds little meaningful benefit in terms of biochemical control for IR men treated with low-dose-rate brachytherapy but likely decreases overall survival because of increased cardiac mortality. IR patients were older and had more cardiac risk factors than LR prostate cases; this may be because of a screening effect, case selection, or common etiologic cause.

摘要

目的

确定6个月的辅助雄激素剥夺疗法（ADT）联合近距离放射疗法治疗中危（IR）和低危（LR）前列腺癌是否会增加心血管死亡风险。

方法和材料

这是一项对1998年至2012年在不列颠哥伦比亚癌症机构近距离放射治疗项目中接受治疗的男性前瞻性收集数据的回顾性分析。根据风险组和ADT使用情况对男性进行分类。记录并比较各组的心脏和其他合并症。确定生化控制情况（凤凰城定义，最低点+2 ng/mL）。总体而言，采用Kaplan-Meier方法和Fine and Gray竞争风险分析对前列腺、心脏和其他原因导致的死亡率进行分析。

结果

该研究纳入了3155名男性（1142例为LR癌症，2013例为IR癌症），中位随访时间为7.9年。47%的IR患者和37%的LR患者接受了ADT，中位时间为6个月。与LR患者相比，IR癌症患者年龄更大，心脏和其他合并症更多（P<0.01）。使用ADT后，10年时生化控制率从86%提高到89%（P=0.006）。接受ADT的患者总体生存率较低（10年时为84%对86%，P=0.0274），在竞争风险分析中，接受ADT的患者中，IR病例的心血管死亡率较高，10年时为5.2%对3.6%（P=0.0493），但LR病例中并非如此。多因素分析证实接受ADT的IR患者心脏死亡率增加（风险比，1.95[95%置信区间，1.15 - 3.34]；P=0.014）。