Department of Urology, Seoul St. Mary's Hospital, College of Medicine, Seoul.
The Cancer Research Institute, The Catholic University of Korea, Seoul.
J Natl Compr Canc Netw. 2019 May 1;17(5):441-449. doi: 10.6004/jnccn.2018.7265.
We conducted a comparative survival analysis between primary androgen deprivation therapy (PADT) and radical prostatectomy (RP) based on nationwide Korean population data that included all patients with prostate cancer.
This study enrolled 4,538 patients with prostate cancer from the National Health Insurance Service (NHIS) database linked with Korean Central Cancer Registry data who were treated with PADT or RP between January 1, 2007, and December 31, 2014. Kaplan-Meier and multivariate survival analyses stratified by stage (localized and locally advanced) and age (<75 and ≥75 years) were performed using a Cox proportional hazards model to evaluate treatment effects.
Among 18,403 patients from the NHIS database diagnosed with prostate cancer during the study period, 4,538 satisfied inclusion criteria and were included in the analyses. Of these, 3,136 and 1,402 patients underwent RP or received PADT, respectively. Risk of death was significantly increased for patients who received PADT compared with those who underwent RP in the propensity score-matched cohort. In subgroup analyses stratified by stage and age, in every subgroup, patients who received PADT had a significantly increased risk of death compared with those who underwent RP. In particular, a much greater risk was observed for patients with locally advanced prostate cancer.
Based on a nationwide survival analysis of nonmetastatic prostate cancer, this study provides valuable clinical implications that favor RP over PDAT for treatment of Asian populations. However, the possibility that survival differences have been overestimated due to not accounting for potential confounding characteristics must be considered.
我们基于包括所有前列腺癌患者的全国韩国人群数据进行了原发雄激素剥夺治疗（PADT）和根治性前列腺切除术（RP）的生存比较分析。
本研究纳入了 2007 年 1 月 1 日至 2014 年 12 月 31 日期间，在国家健康保险服务（NHIS）数据库中接受 PADT 或 RP 治疗的 4538 例前列腺癌患者，该数据库与韩国中央癌症登记处数据相关联。采用 Kaplan-Meier 法和多变量生存分析，按分期（局限性和局部进展性）和年龄（<75 岁和≥75 岁）分层，使用 Cox 比例风险模型评估治疗效果。
在研究期间，NHIS 数据库中诊断为前列腺癌的 18403 例患者中，有 4538 例符合纳入标准并纳入分析。其中，3136 例和 1402 例患者分别接受了 RP 或 PADT。在倾向评分匹配队列中，接受 PADT 的患者死亡风险明显高于接受 RP 的患者。在按分期和年龄分层的亚组分析中，在每个亚组中，接受 PADT 的患者死亡风险均明显高于接受 RP 的患者。特别是局部进展性前列腺癌患者的风险更高。
基于非转移性前列腺癌的全国生存分析，本研究为亚洲人群的治疗提供了有价值的临床意义，支持 RP 优于 PADT。然而，由于未考虑潜在的混杂特征，可能高估了生存差异，这一点必须考虑。
