Grapin Mathieu, Quivrin Magali, Bertaut Aurélie, Martin Etienne, Cormier Luc, Ladoire Sylvain, Cochet Alexandre, Créhange Gilles
Department of Radiation Oncology, Unicancer-Georges-Francois Leclerc Cancer Center, Dijon, France.
Methodology, Data-Management, and Biostatistics Unit, Unicancer-Georges-Francois Leclerc Cancer Center, Dijon, France.
Front Oncol. 2019 Feb 15;9:70. doi: 10.3389/fonc.2019.00070. eCollection 2019.
External beam radiation therapy (EBRT) can cure localized prostate cancer (PCa) by sterilizing cancer cells in the prostate gland and surrounding tissues at risk of microscopic dissemination. We hypothesized that pelvic EBRT for localized PCa might have an unexpected prophylactic impact on the occurrence of pelvic bone metastases. We reviewed the data of 332 metastatic PCa patients. We examined associations between the number (≤5 vs. >5) and the location of bone metastases (in-field vs. out-of-field), which occurred at first relapse, and a previous history of EBRT for PCa (EBRT vs. No-EBRT). One hundred and ten patients M0 at baseline were eligible. Fifty-six patients (51%) were in the No-EBRT group, and 54 patients (49%) in the EBRT group. The proportion of patients who developed >5 bone metastases in the bony pelvis was higher in the No-EBRT group vs. the EBRT group: 10 patients (18%) vs. 2 patients (4%), respectively ( = 0.02). By multivariate analysis EBRT was associated with a lesser occurrence of patients who had >5 bone metastases in the bony pelvis (OR = 0.17 [95%CI, 0.04-0.87], = 0.03). Time to occurrence of bone metastases ≥5 years (OR = 0.10 [95%CI, 0.05-0.19], < 0.01), prior curative prostate treatment (OR = 0.58 [95%CI, 0.36-0.91], = 0.02), >5 bone metastases in bony pelvis (OR = 2.61 [95%CI, 1.28-5.31], < 0.01), >5 bone metastases out of bony pelvis (OR = 1.73 [95%CI, 1.09-2.76], = 0.02) were all predictive of overall survival. Previous pelvic EBRT for PCa is associated with a lower number of pelvic bone metastases, which is associated with better overall survival.
外照射放疗（EBRT）可通过杀灭前列腺腺体内及有微小播散风险的周围组织中的癌细胞来治愈局限性前列腺癌（PCa）。我们推测，针对局限性PCa的盆腔EBRT可能对盆腔骨转移的发生有意外的预防作用。我们回顾了332例转移性PCa患者的数据。我们研究了初次复发时发生的骨转移数量（≤5个与>5个）和位置（野内与野外）与既往PCa的EBRT史（EBRT与未行EBRT）之间的关联。110例基线时为M0的患者符合条件。56例患者（51%）在未行EBRT组，54例患者（49%）在EBRT组。未行EBRT组发生>5个盆腔骨转移的患者比例高于EBRT组：分别为10例患者（18%）与2例患者（4%）（P = 0.02）。通过多因素分析，EBRT与盆腔骨转移>5个的患者发生率较低相关（OR = 0.17 [95%CI，0.04 - 0.87]，P = 0.03）。骨转移发生时间≥5年（OR = 0.10 [95%CI，0.05 - 0.19]，P < 0.01）、既往前列腺根治性治疗（OR = 0.58 [95%CI，0.36 - 0.91]，P = 0.02）、盆腔骨转移>5个（OR = 2.61 [95%CI，1.28 - 5.31]，P < 0.01）、盆腔外骨转移>5个（OR = 1.73 [95%CI，1.09 - 2.76]，P = 0.02）均为总生存的预测因素。既往针对PCa的盆腔EBRT与盆腔骨转移数量较少相关，而这与更好的总生存相关。
