Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
JAMA Oncol. 2019 Feb 1;5(2):213-220. doi: 10.1001/jamaoncol.2018.4836.
It is unknown how treatment with radical prostatectomy (RP) and adjuvant external beam radiotherapy (EBRT), androgen deprivation therapy (ADT), or both (termed MaxRP) compares with treatment with EBRT, brachytherapy, and ADT (termed MaxRT).
To investigate whether treatment of Gleason score 9-10 prostate cancer with MaxRP vs MaxRT was associated with prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) risk.
DESIGN, SETTING, AND PARTICIPANTS: The study cohort comprised 639 men with clinical T1-4,N0M0 biopsy Gleason score 9-10 prostate cancer. Between February 6, 1992, and April 26, 2013, a total of 80 men were consecutively treated with MaxRT at the Chicago Prostate Cancer Center, and 559 men were consecutively treated with RP and pelvic lymph node dissection at the Martini-Klinik Prostate Cancer Center. Follow-up started on the day of prostate EBRT or RP and concluded on October 27, 2017.
Of the 559 men managed with RP and pelvic lymph node dissection, 88 (15.7%) received adjuvant EBRT, 49 (8.8%) received ADT, and 50 (8.9%) received both.
Treatment propensity score-adjusted risk of PCSM and ACM and the likelihood of equivalence of these risks between treatments using a plausibility index.
The cohort included 639 men, with a mean (SD) age of 65.83 (6.52) years. After median follow-ups of 5.51 years (interquartile range, 2.19-6.95 years) among 80 men treated with MaxRT and 4.78 years (interquartile range, 4.01-6.05 years) among 559 men treated with RP-containing treatments, 161 men had died, 106 (65.8%) from prostate cancer. There was no significant difference in the risk of PCSM (adjusted hazard ratio, 1.33; 95% CI, 0.49-3.64; P = .58) and ACM (adjusted hazard ratio, 0.80; 95% CI, 0.36-1.81; P = .60) when comparing men who underwent MaxRP vs MaxRT, with plausibility indexes for equivalence of 76.75% for the end point of the risk of PCSM and 77.97% for the end point of the risk of ACM. Plausibility indexes for all other treatment comparisons were less than 63%.
Results of this study suggest that it is plausible that treatment with MaxRP or MaxRT for men with biopsy Gleason score 9-10 prostate cancer can lead to equivalent risk of PCSM and ACM.
目前尚不清楚根治性前列腺切除术 (RP) 和辅助外照射放疗 (EBRT)、雄激素剥夺治疗 (ADT) 或两者联合治疗 (称为 MaxRP) 与 EBRT、近距离放射治疗和 ADT 联合治疗 (称为 MaxRT) 的疗效相比如何。
研究 Gleason 评分 9-10 前列腺癌患者接受 MaxRP 与 MaxRT 治疗与前列腺癌特异性死亡率 (PCSM) 和全因死亡率 (ACM) 风险之间的关系。
设计、地点和参与者：研究队列包括 639 名临床 T1-4、N0M0 活检 Gleason 评分 9-10 前列腺癌患者。1992 年 2 月 6 日至 2013 年 4 月 26 日，共有 80 名患者在芝加哥前列腺癌中心连续接受 MaxRT 治疗，559 名患者在 Martini-Klinik 前列腺癌中心接受 RP 和盆腔淋巴结清扫术治疗。随访于前列腺 EBRT 或 RP 当日开始，于 2017 年 10 月 27 日结束。
559 名接受 RP 和盆腔淋巴结清扫术治疗的患者中，88 名（15.7%）接受辅助 EBRT，49 名（8.8%）接受 ADT，50 名（8.9%）同时接受两种治疗。
使用合理性指数，对 PCSM 和 ACM 风险的治疗倾向评分调整风险以及这些风险在治疗之间等效的可能性进行评估。
该队列包括 639 名患者，平均（SD）年龄为 65.83（6.52）岁。在接受 MaxRT 治疗的 80 名患者中，中位随访时间为 5.51 年（四分位距，2.19-6.95 年），接受 RP 治疗的 559 名患者中，中位随访时间为 4.78 年（四分位距，4.01-6.05 年），随访期间共有 161 名患者死亡，其中 106 名（65.8%）死于前列腺癌。与接受 MaxRT 治疗的患者相比，接受 MaxRP 治疗的患者 PCSM（调整后危险比，1.33；95%CI，0.49-3.64；P=0.58）和 ACM（调整后危险比，0.80；95%CI，0.36-1.81；P=0.60）风险无显著差异，PCSM 风险等效性的合理性指数为 76.75%，ACM 风险等效性的合理性指数为 77.97%。其他所有治疗比较的合理性指数均低于 63%。
本研究结果表明，对于 Gleason 评分 9-10 前列腺癌患者，接受 MaxRP 或 MaxRT 治疗可能导致 PCSM 和 ACM 风险相当，这是合理的。
