根治性前列腺切除术后生化失败的前列腺癌患者选择性盆腔放疗：倾向评分匹配分析。
Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis.
机构信息
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
出版信息
PLoS One. 2019 Apr 11;14(4):e0215057. doi: 10.1371/journal.pone.0215057. eCollection 2019.
PURPOSE
To investigate whether whole pelvic radiotherapy (WPRT) improves biochemical relapse-free survival (bRFS) vs. prostate bed radiotherapy (PBRT) in prostate cancer patients receiving salvage radiotherapy (SRT) after radical prostatectomy.
METHODS
Data from patients with prostate cancer who underwent SRT for biochemical recurrence between 2005 and 2012 in two academic institutions were retrospectively reviewed. Patients treated with WPRT in one hospital were compared with patients treated with PBRT in the other. Propensity scoring was performed to balance the characteristics of the different treatment groups, and bRFS was compared.
RESULTS
Data from a total of 191 patients were included in the analysis (WPRT, n = 108; PBRT, n = 83). The median follow-up period was 66 months. Prior to matching, patients who received WPRT had higher pathologic Gleason scores as well as a higher incidence of pre-SRT PSA levels >0.5 ng/mL and lower rates of concurrent androgen-deprivation therapy. Propensity score matching balanced these characteristics and generated a cohort comprising 56 patients from each group. In the matched cohort, the 5 year bRFS of the WPRT group was significantly higher than that of the PBRT group (65.9 vs. 42.2%, p = 0.017). Multivariate analysis revealed that WPRT was an independent prognostic factor for bRFS (hazard ratio: 0.45, 95% confidence interval: 0.26-0.75, p = 0.002). This benefit of WPRT on bRFS was maintained in subgroup analyses, especially in patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL.
CONCLUSIONS
These data suggest that, following radical prostatectomy, elective WPRT during SRT may improve bRFS compared with PBRT in selected patients. Patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL represent a potential subgroup who benefit most from receiving WPRT. Results of prospective randomized trials are awaited to confirm this finding.
目的
研究在根治性前列腺切除术后接受挽救性放疗（SRT）的前列腺癌患者中，全盆腔放疗（WPRT）是否比前列腺床放疗（PBRT）更能改善生化无复发生存（bRFS）。
方法
回顾性分析了 2005 年至 2012 年在两个学术机构接受 SRT 治疗生化复发的前列腺癌患者的数据。比较了一家医院接受 WPRT 治疗的患者和另一家医院接受 PBRT 治疗的患者。进行倾向评分以平衡不同治疗组的特征，并比较 bRFS。
结果
共纳入 191 例患者（WPRT 组 108 例，PBRT 组 83 例）进行分析。中位随访时间为 66 个月。在匹配前，接受 WPRT 的患者具有更高的病理 Gleason 评分，并且更常见的是在 SRT 前 PSA 水平>0.5ng/ml，同时接受同期雄激素剥夺治疗的比例较低。倾向评分匹配平衡了这些特征，并产生了一组来自每组的 56 例患者。在匹配队列中，WPRT 组的 5 年 bRFS 明显高于 PBRT 组（65.9% vs. 42.2%，p=0.017）。多因素分析显示，WPRT 是 bRFS 的独立预后因素（风险比：0.45，95%置信区间：0.26-0.75，p=0.002）。在亚组分析中，WPRT 对 bRFS 的这种获益得到了维持，特别是在术前 PSA 水平≤20ng/ml 或 SRT 前 PSA 水平≥0.4ng/ml 的患者中。
结论
这些数据表明，在根治性前列腺切除术后，SRT 期间选择性进行全盆腔放疗可能比前列腺床放疗更能改善选定患者的生化无复发生存。术前 PSA 水平≤20ng/ml 或 SRT 前 PSA 水平≥0.4ng/ml 的患者最有可能从接受全盆腔放疗中获益。需要前瞻性随机试验的结果来证实这一发现。
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