Dell'Oglio Paolo, Bandini Marco, Leyh-Bannurah Sami-Ramzi, Tian Zhe, Trudeau Vincent, Larcher Alessandro, Fossati Nicola, Moschini Marco, Gandaglia Giorgio, Capitanio Umberto, Briganti Alberto, Graefen Markus, Montorsi Francesco, Saad Fred, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Oncology/Unit of Urology; Urological Research Institute; IRCCS Ospedale San Raffaele, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Oncology/Unit of Urology; Urological Research Institute; IRCCS Ospedale San Raffaele, Milan, Italy.
Urol Oncol. 2018 May;36(5):239.e9-239.e15. doi: 10.1016/j.urolonc.2018.01.004. Epub 2018 Feb 14.
Several randomized controlled trials have documented significant overall survival benefit in high metastatic risk prostate cancer (PCa) patients treated with combination of androgen deprivation therapy (ADT) at radiotherapy (RT) relative to RT alone. Unfortunately, elderly patients are either not included or are underrepresented in these trials. In consequence, the survival benefit of combination of ADT at RT in the elderly warrants detailed reassessment, including its cost.
Between 1991 and 2009 within the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, we identified 3,692 patients aged 80 years or more with clinical T1-T2 PCa and WHO histological grade 3, or clinical T3-T4 PCa and any histological grade, treated with or without combination of ADT at RT. Competing risks analyses focused on cancer-specific mortality (CSM) and other-cause mortality, after accounting for confounders. All analyses were repeated in patients with no comorbidity and in most contemporary patients, treated between 2001 and 2009. Finally, we assessed median annual cost according to use of combination of ADT at RT, after adjusting for patient and tumor characteristics.
In competing-risks multivariable analyses, no statistically significant difference was observed in CSM and other-cause mortality between patients treated with or without combination of ADT at RT. Same results were recorded in subgroup analyses of patients with no comorbidity and in most contemporary patients. The median annual costs of $36,140 and of $47,510 were recorded, respectively in patients treated without and with ADT at RT.
Our findings failed to confirm that combination of ADT at RT reduces CSM rates in high metastatic risk PCa patients aged 80 years or more. Moreover, combination of ADT at RT resulted in a significant cost increase, relative to RT alone.
多项随机对照试验已证明，与单纯放疗相比，高转移风险前列腺癌（PCa）患者在放疗（RT）时联合雄激素剥夺疗法（ADT）可显著提高总生存率。遗憾的是，这些试验未纳入老年患者或老年患者占比过低。因此，放疗时联合ADT对老年患者的生存获益，包括其成本，值得进行详细重新评估。
在1991年至2009年期间的监测、流行病学和最终结果（SEER）与医疗保险关联数据库中，我们识别出3692例年龄在80岁及以上的患者，这些患者患有临床T1 - T2期PCa且世界卫生组织组织学分级为3级，或临床T3 - T4期PCa且任何组织学分级，接受或未接受放疗时联合ADT治疗。在考虑混杂因素后，竞争风险分析聚焦于癌症特异性死亡率（CSM）和其他原因死亡率。所有分析在无合并症患者以及2001年至2009年期间接受治疗的大多数当代患者中重复进行。最后，在调整患者和肿瘤特征后，我们根据放疗时联合ADT的使用情况评估了中位年度成本。
在竞争风险多变量分析中，放疗时接受或未接受联合ADT治疗的患者之间，CSM和其他原因死亡率未观察到统计学上的显著差异。在无合并症患者和大多数当代患者的亚组分析中也记录到了相同结果。放疗时未接受ADT治疗和接受ADT治疗的患者中位年度成本分别为36,140美元和47,510美元。
我们的研究结果未能证实放疗时联合ADT可降低80岁及以上高转移风险PCa患者的CSM率。此外，放疗时联合ADT相对于单纯放疗导致成本显著增加。
