Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
Clin Genitourin Cancer. 2019 Apr;17(2):e329-e338. doi: 10.1016/j.clgc.2018.12.010. Epub 2019 Jan 4.
The objective of the study was to evaluate the outcomes of clinically localized prostate cancer treated with prostatectomy versus radiation therapy within the context of a prospective prostate cancer screening study.
Within the PLCO (Prostate, Lung, Colorectal, and Ovary) trial, patients who were diagnosed with clinically localized prostate cancer and subsequently received treatment with prostatectomy or radiation therapy (with or without hormonal treatment) were included. Univariate and multivariate Cox regression analyses were then performed to determine factors affecting overall and prostate cancer-specific survival. Factors with P < .05 in univariate analysis were included in the multivariate analysis.
A total of 3953 patients were included in the current analysis. These included 2044 patients treated with prostatectomy and 1909 patients treated with radiation therapy with or without hormonal treatment. In an adjusted multivariate analysis for factors affecting overall survival, prostatectomy was associated with better overall survival compared with radiation therapy (hazard ratio, 0.548; 95% confidence interval [CI], 0.440- 681; P < .001). Likewise, in an adjusted multivariate analysis for factors affecting prostate cancer-specific survival, prostatectomy was associated with better prostate cancer-specific survival compared with radiation therapy (hazard ratio, 0.485; 95% CI, 0.286- 0.822; P = .007). Similar findings were found with propensity score matching and repeating the same analyses on the post-matching cohort.
Prostatectomy seems to predict better overall and prostate cancer-specific survival compared with radiation therapy among patients with clinically localized prostate cancer diagnosed within the PLCO trial.
本研究旨在评估在一项前列腺癌筛查前瞻性研究中，前列腺切除术与放射治疗治疗局限性前列腺癌的结局。
在 PLCO（前列腺、肺、结直肠和卵巢）试验中，纳入了被诊断为局限性前列腺癌且随后接受前列腺切除术或放射治疗（伴或不伴激素治疗）的患者。然后进行单变量和多变量 Cox 回归分析，以确定影响总生存和前列腺癌特异性生存的因素。单变量分析中 P 值<.05 的因素纳入多变量分析。
共纳入 3953 例患者，包括接受前列腺切除术治疗的 2044 例患者和接受放射治疗（伴或不伴激素治疗）的 1909 例患者。在多变量分析中调整了影响总生存的因素后，前列腺切除术与放射治疗相比，总生存更优（风险比，0.548；95%置信区间[CI]，0.440-681；P<.001）。同样，在多变量分析中调整了影响前列腺癌特异性生存的因素后，前列腺切除术与放射治疗相比，前列腺癌特异性生存更优（风险比，0.485；95%CI，0.286-0.822；P=.007）。在倾向评分匹配后也得到了相似的发现，并在匹配后队列中重复了相同的分析。
在 PLCO 试验中诊断为局限性前列腺癌的患者中，与放射治疗相比，前列腺切除术似乎能更好地预测总生存和前列腺癌特异性生存。
