Kim Albert H, Konety Badrinath, Chen Zhengyi, Schumacher Fredrick, Kutikov Alexander, Smaldone Marc, Abouassaly Robert, Khanna Abhinav, Kim Simon P
University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH.
Masonic Cancer Center, Department of Urology, University of Minnesota Health System, Minneapolis, MN.
Urology. 2018 Oct;120:173-179. doi: 10.1016/j.urology.2018.06.038. Epub 2018 Jul 7.
To evaluate the comparative effectiveness of local vs systemic therapy among patients diagnosed with nonmetastatic clinical T4 prostate cancer.
Using the National Cancer Database men with clinical T4N0-1M0 prostate cancer from 2004 to 2013 were identified. Local therapy was defined as radiation (RT with androgen deprivation therapy [ADT]), surgery (radical prostatectomy with ADT), or combined radiation plus surgery (radical prostatectomy plus RT with ADT). Systemic therapy was defined as ADT or chemotherapy alone. The primary outcome of overall survival was estimated using the Kaplan-Meier method. Factors associated with overall survival were determined by Cox proportional hazards models.
A total of 1914 patients were included in our analysis, 1559 received local therapy and 355 received systemic therapy. Median 5-year survival for local vs systemic therapy was 41.5 and 28.2 months, respectively. On multivariable analysis, local therapy was associated with increased overall survival compared to systemic therapy (hazard ratio [HR] = 0.52; 95% confidence interval [CI] 0.44-0.62, P < .001). Comparing local therapy treatment modalities, both radiation (HR = 0.44; 95% CI 0.36-0.53, P < .001) and surgery (HR = 0.67; 95% CI 0.55-0.82, P < .001) were associated with increased overall survival compared to systemic therapy. Among those receiving local therapy, more patients were treated with radiation (n = 709/1559 or 45.5%) compared to surgery (n = 560/1559 or 35.9%) or combined radiation plus surgery (n = 290/1559 or 18.6%) with 5-year overall survival by treatment type being 61%, 51.4%, and 62.2%, respectively.
Local therapy for clinical T4 prostate cancer is associated with improved overall survival. Due to the retrospective, nonrandomized nature of the study design, a clinical trial is needed to better define the efficacy of local therapy in this high-risk patient population.
评估局部治疗与全身治疗在诊断为非转移性临床T4期前列腺癌患者中的相对疗效。
利用国家癌症数据库，确定了2004年至2013年患有临床T4N0-1M0前列腺癌的男性患者。局部治疗定义为放疗（雄激素剥夺治疗[ADT]联合放疗[RT]）、手术（ADT联合根治性前列腺切除术）或放疗联合手术（ADT联合根治性前列腺切除术加RT）。全身治疗定义为单独使用ADT或化疗。采用Kaplan-Meier法估计总生存的主要结局。通过Cox比例风险模型确定与总生存相关的因素。
共有1914例患者纳入我们的分析，1559例接受局部治疗，355例接受全身治疗。局部治疗与全身治疗的5年中位生存期分别为41.5个月和28.2个月。多变量分析显示，与全身治疗相比，局部治疗与总生存增加相关（风险比[HR]=0.52；95%置信区间[CI]0.44-0.62，P<.001）。比较局部治疗方式，与全身治疗相比，放疗（HR=0.44；95%CI 0.36-0.53，P<.001）和手术（HR=0.67；95%CI 0.55-0.82，P<.001）均与总生存增加相关。在接受局部治疗的患者中，接受放疗的患者（n=709/1559或45.5%）多于接受手术的患者（n=560/1559或35.9%）或放疗联合手术的患者（n=290/1559或18.6%），按治疗类型的5年总生存率分别为61%、51.4%和62.2%。
临床T4期前列腺癌的局部治疗与总生存改善相关。由于本研究设计具有回顾性、非随机性质，因此需要进行一项临床试验，以更好地确定局部治疗在这一高危患者群体中的疗效。
