患者的临床结局格利森评分 10 前列腺腺癌：从一个多机构联盟研究的结果。
Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma: Results From a Multi-institutional Consortium Study.
机构信息
Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California.
Department of Epidemiology, Fielding School of Public Health at UCLA, Los Angeles, California.
出版信息
Int J Radiat Oncol Biol Phys. 2018 Jul 15;101(4):883-888. doi: 10.1016/j.ijrobp.2018.03.060. Epub 2018 Apr 5.
PURPOSE
Gleason score (GS) 10 disease is the most aggressive form of clinically localized prostate adenocarcinoma (PCa). The long-term clinical outcomes and overall prognosis of patients presenting with GS 10 PCa are largely unknown because of its rarity.
METHODS AND MATERIALS
The study included 112 patients with biopsy-determined GS 10 PCa who received treatment with radical prostatectomy (RP, n = 26), external beam radiation therapy (EBRT, n = 48), or EBRT with a brachytherapy boost (EBRT-BT, n = 38) between 2000 and 2013. Propensity scores were included as covariates for comparative analysis. Overall survival, prostate cancer-specific survival, and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method with inverse probability of treatment weighting to control for confounding.
RESULTS
The median follow-up period was 4.9 years overall (3.9 years for RP, 4.8 years for EBRT, and 5.7 years for EBRT-BT). Significantly more EBRT patients than EBRT-BT patients received upfront androgen deprivation therapy (98% vs 79%, P < .01 by χ test), though the durations were similar (median, 24 months vs 22.5 months). Of the RP patients, 34% received postoperative EBRT, and 35% received neoadjuvant systemic therapy. The propensity score-adjusted 5-year overall survival rate was 80% for the RP group, 73% for the EBRT group, and 83% for the EBRT-BT group. The corresponding adjusted 5-year prostate cancer-specific survival rates were 87%, 75%, and 94%, respectively. The EBRT-BT group trended toward superior DMFS when compared with the RP group (hazard ratio, 0.3; 95% confidence interval 0.1-1.06; P = .06) and had superior DMFS when compared with the EBRT group (hazard ratio, 0.4; 95% confidence interval 0.1-0.99; P = .048).
CONCLUSIONS
To our knowledge, this is the largest series ever reported on the clinical outcomes of patients with biopsy-determined GS 10 PCa. These data provide useful prognostic benchmark information for physicians and patients. Aggressive therapy with curative intent is warranted, as >50% of patients remain free of systemic disease 5 years after treatment.
目的
格里森评分（GS）10 级疾病是临床局限性前列腺腺癌（PCa）中最具侵袭性的形式。由于其罕见性，目前尚不清楚表现为 GS 10 PCa 的患者的长期临床结局和总体预后。
方法与材料
这项研究纳入了 112 名经活检证实患有 GS 10 PCa 的患者，他们在 2000 年至 2013 年间接受了根治性前列腺切除术（RP，n=26）、外照射放疗（EBRT，n=48）或 EBRT 加近距离放疗（EBRT-BT，n=38）治疗。采用倾向评分作为协变量进行比较分析。通过逆概率处理权重法估计总生存率、前列腺癌特异性生存率和无远处转移生存率（DMFS），以控制混杂因素。
结果
中位随访时间为 4.9 年（RP 组为 3.9 年，EBRT 组为 4.8 年，EBRT-BT 组为 5.7 年）。与 EBRT-BT 组相比，EBRT 组患者接受初始雄激素剥夺治疗的比例明显更高（98%比 79%，χ²检验，P<0.01），但持续时间相似（中位时间分别为 24 个月和 22.5 个月）。RP 组中有 34%的患者接受了术后 EBRT，35%的患者接受了新辅助系统治疗。RP 组、EBRT 组和 EBRT-BT 组校正后 5 年总生存率分别为 80%、73%和 83%。相应的校正后 5 年前列腺癌特异性生存率分别为 87%、75%和 94%。与 RP 组相比，EBRT-BT 组的无远处转移生存率（DMFS）有改善趋势（风险比 0.3；95%置信区间 0.1-1.06；P=0.06），与 EBRT 组相比，EBRT-BT 组的 DMFS 有改善趋势（风险比 0.4；95%置信区间 0.1-0.99；P=0.048）。
结论
据我们所知，这是迄今为止关于经活检证实患有 GS 10 PCa 的患者临床结局的最大系列研究。这些数据为医生和患者提供了有用的预后基准信息。需要进行积极的根治性治疗，因为>50%的患者在治疗后 5 年内仍无全身性疾病。
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