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.
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.
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.
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.
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).
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.
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。
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。
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）。
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。
