Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Department of Urology, Albert Ludwig University Hospital, Freiburg, Germany.
Eur Urol Focus. 2019 Nov;5(6):1007-1013. doi: 10.1016/j.euf.2018.02.015. Epub 2018 Mar 10.
Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes.
To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT).
DESIGN, SETTING, AND PARTICIPANTS: PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis.
The SOC cohort (n=1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n=263) received either salvage lymph node dissection (n=166) or stereotactic body radiotherapy (n=97) at PSA progression to a positron emission tomography-detected nodal recurrence.
The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses.
At a median follow-up of 70 (interquartile range: 48-98) mo, MDT was associated with an improved CSS on univariate (p=0.029) and multivariate analysis (hazard ratio: 0.33, 95% confidence interval [CI]: 0.17-0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6% (95% CI: 94.3-99.6) and 95.7% (95% CI: 93.2-97.3) for MDT and SOC, respectively (p=0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort.
MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting.
Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at these lymph nodes.
大多数接受过初级多模态治疗（手术和术后放疗）的前列腺癌（PCa）患者在生化失败后会在淋巴结中复发。
对多模态治疗后前列腺特异性抗原（PSA）进展的局部淋巴结复发 PCa 患者进行标准治疗（SOC）与转移导向治疗（MDT）的匹配病例分析。
设计、地点和参与者：这项回顾性多机构分析纳入了多模态治疗后 PSA 进展的局限性前列腺癌患者。
SOC 队列（n=1816）在 PSA 进展时接受即刻或延迟雄激素剥夺治疗。MDT 队列（n=263）在 PSA 进展时接受正电子发射断层扫描检测到的淋巴结复发的挽救性淋巴结清扫术（n=166）或立体定向体放射治疗（n=97）。
使用 Kaplan-Meier 方法、对数秩检验、Cox 比例风险模型和倾向评分匹配分析来分析主要终点，即癌症特异性生存（CSS）。
中位随访 70（四分位间距：48-98）mo 时，MDT 与单变量（p=0.029）和多变量分析（危险比：0.33，95%置信区间[CI]：0.17-0.64）相关，校正了根治性前列腺切除术（RP）的年份、RP 时的年龄、RP 时的 PSA、RP 到 PSA 进展的时间、Gleason 评分、手术切缘状态、pT 期和 pN 期。总共匹配了 659 名男性（3:1 比例）。MDT 和 SOC 的 5 年 CSS 分别为 98.6%（95%CI：94.3-99.6）和 95.7%（95%CI：93.2-97.3）（p=0.005，对数秩）。本研究的主要局限性在于其回顾性设计和 SOC 队列中缺乏系统治疗的标准化。
与 SOC 相比，MDT 治疗局部淋巴结寡复发 PCa 可提高 CSS。来自多机构 pooled 分析的这些回顾性数据应被视为产生假说，并为该领域的未来随机试验提供信息。
出现淋巴结复发的前列腺癌患者可能会受益于针对这些淋巴结的局部治疗。
