Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Urol Oncol. 2019 Jun;37(6):353.e1-353.e8. doi: 10.1016/j.urolonc.2018.12.022. Epub 2019 Jan 2.
Controversy surrounds the benefit of pelvic lymph node irradiation (PLN-RT) in localized prostate cancer (CaP). Our objective was to determine the practice patterns and predictors of PLN-RT in a national cohort.
The National Cancer Data Base (2005-2015) was leveraged to obtain men diagnosed with nonmetastatic CaP treated with external beam radiotherapy (n = 197,378). Multivariable logistic regressions were used to assess temporal trends and factors associated with PLN-RT.
PLN-RT occurred in 37% of patients overall, which increased to 41% by 2015. When stratified by risk group, there was no significant difference in PLN-RT over time in low, favorable intermediate, unfavorable intermediate, or high-risk CaP. PLN-RT increased for men with very high-risk disease (51%-60%; odds ratio per year 1.34, 95% confidence inrerval 1.06-1.70, P = 0.013). Increased odds of PLN-RT was associated with higher risk disease, addition of hormone therapy, treatment at community hospitals, and shorter patient travel distance to treatment facilities. Surprisingly, 26% and 34% of low and favorable intermediate risk CaP received PLN-RT, respectively. Predictors of PLN-RT among these patients included treatment at a community practice and use of brachytherapy or hormone therapy.
PLN-RT occurred in about one-third of men receiving external beam radiotherapy and increased over time, mostly in men with very high-risk CaP for unclear reasons. Of concern, over one-quarter of low-risk men receive PLN-RT. Further work is needed to understand the heterogeneity in PLN-RT use. We await the completion of RTO G 09-24 to better understand the role of PLN-RT for men with localized CaP.
局部前列腺癌（CaP）中，盆腔淋巴结照射（PLN-RT）的益处存在争议。我们的目的是在全国队列中确定 PLN-RT 的实践模式和预测因素。
利用国家癌症数据库（2005-2015 年）获取诊断为非转移性 CaP 并接受外照射放射治疗（n=197378）的患者。采用多变量逻辑回归评估 PLN-RT 的时间趋势和相关因素。
PLN-RT 在总体患者中占 37%，到 2015 年增加到 41%。按风险组分层，低、中低、中高和高危 CaP 的 PLN-RT 时间无显著差异。极高危疾病（51%-60%）的患者接受 PLN-RT 的比例增加（每年优势比 1.34，95%置信区间 1.06-1.70，P=0.013）。PLN-RT 增加与疾病高危、激素治疗的添加、社区医院治疗以及患者到治疗设施的旅行距离缩短有关。令人惊讶的是，分别有 26%和 34%的低危和中低危 CaP 患者接受了 PLN-RT。这些患者接受 PLN-RT 的预测因素包括在社区实践中治疗和使用近距离放射治疗或激素治疗。
约三分之一接受外照射放射治疗的患者接受了 PLN-RT，且随着时间的推移呈增加趋势，主要是在高危 CaP 患者中，原因不明。令人担忧的是，超过四分之一的低危男性接受了 PLN-RT。需要进一步研究来了解 PLN-RT 使用的异质性。我们正在等待 RTOG 09-24 的完成，以更好地了解 PLN-RT 在局部 CaP 男性中的作用。
