Takamoto Atsushi, Tanimoto Ryuta, Bekku Kensuke, Araki Motoo, Sadahira Takuya, Wada Koichiro, Ebara Shin, Katayama Norihisa, Yanai Hiroyuki, Nasu Yasutomo
Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Int J Urol. 2018 May;25(5):507-512. doi: 10.1111/iju.13555. Epub 2018 Apr 12.
To determine whether neoadjuvant hormonal therapy improves oncological outcomes of patients with localized prostate cancer treated with permanent brachytherapy.
Between January 2004 and November 2014, 564 patients underwent transperineal ultrasonography-guided permanent iodine-125 seed brachytherapy. We retrospectively analyzed low- or intermediate-risk prostate cancer based on the National Comprehensive Cancer Network guidelines. The clinical variables were evaluated for influence on biochemical recurrence-free survival, progression-free survival, cancer-specific survival and overall survival.
A total of 484 patients with low-risk (259 patients) or intermediate-risk disease (225 patients) were evaluated. Of these, 188 received neoadjuvant hormonal therapy. With a median follow up of 71 months, the 5-year actuarial biochemical recurrence-free survival rates of patients who did and did not receive neoadjuvant hormonal therapy were 92.9% and 93.6%, respectively (P = 0.2843). When patients were stratified by risk group, neoadjuvant hormonal therapy did not improve biochemical recurrence-free survival outcomes in low- (P = 0.8949) or intermediate-risk (P = 0.1989) patients. The duration or type of hormonal therapy was not significant in predicting biochemical recurrence. In a multivariate analysis, Gleason score, pretreatment prostate-specific antigen, clinical T stage, and prostate dosimetry, primary Gleason score and positive core rate were significant predictive factors of biochemical recurrence-free survival, whereas neoadjuvant hormonal therapy was insignificant. Furthermore, neoadjuvant hormonal therapy did not significantly influence progression-free survival, cancer-specific survival or overall survival.
In patients with low- or intermediate-risk disease treated with permanent prostate brachytherapy, neoadjuvant hormonal therapy does not improve oncological outcomes. Its use should be restricted to patients who require prostate volume reduction.
确定新辅助激素治疗能否改善接受永久性近距离放射治疗的局限性前列腺癌患者的肿瘤学结局。
2004年1月至2014年11月期间，564例患者接受了经会阴超声引导下的永久性碘-125粒子近距离放射治疗。我们根据美国国立综合癌症网络指南对低危或中危前列腺癌进行了回顾性分析。评估临床变量对无生化复发生存、无进展生存、癌症特异性生存和总生存的影响。
共评估了484例低危（259例）或中危疾病（225例）患者。其中，188例接受了新辅助激素治疗。中位随访71个月，接受和未接受新辅助激素治疗的患者5年精算无生化复发生存率分别为92.9%和93.6%（P = 0.2843）。按风险组分层时，新辅助激素治疗未改善低危（P = 0.8949）或中危（P = 0.1989）患者的无生化复发生存结局。激素治疗的持续时间或类型在预测生化复发方面无显著意义。多因素分析中，Gleason评分、治疗前前列腺特异性抗原、临床T分期和前列腺剂量测定、主要Gleason评分和阳性核心率是无生化复发生存的显著预测因素，而新辅助激素治疗无显著意义。此外，新辅助激素治疗对无进展生存、癌症特异性生存或总生存无显著影响。
在接受永久性前列腺近距离放射治疗的低危或中危疾病患者中，新辅助激素治疗不能改善肿瘤学结局。其应用应限于需要减少前列腺体积的患者。
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