Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy.
Urol Oncol. 2020 Mar;38(3):79.e9-79.e14. doi: 10.1016/j.urolonc.2019.09.015. Epub 2019 Oct 23.
Gleason Score (GS) 9-10 prostate cancer is associated with particularly adverse oncological outcomes and the optimal treatment is unknown. Therefore, cancer-specific mortality (CSM) rates after radical prostatectomy (RP) ± adjuvant radiation therapy (aRT) vs. external beam radiation therapy (EBRT) were tested.
Within the Surveillance, Epidemiology, and End Results database (2004-2015), 17,897 clinically localized prostate cancer patients with biopsy GS 9-10 were identified who either received RP ± aRT or EBRT. Temporal trends, cumulative incidence plots and multivariable competing-risks regression analyses were used after propensity score matching. Sensitivity analyses were performed according to primary treatment type (RP only vs. EBRT).
Of all, 8,890 (49.7%) underwent EBRT vs. 9,007 (50.3%) underwent RP. Of those, 2,584 (28.7%) received aRT. No significant change in treatment assignment was recorded over time. In cumulative incidence smoothed plots, 10 year CSM rates were 19.9% vs. 19.6% (P = 0.3) and 10 year other-cause mortalityrates were 11.5% vs. 31.2%, respectively, in RP vs. EBRT patients (P < 0.001). In multivariable competing-risks regression analyses, RP did not reach independent predictor status of lower CSM (hazard ratio (HR): 0.93, P = 0.2). In sensitivity analyses within RP only vs. EBRT patients, RP represented an independent predictor of lower CSM (HR: 0.76, P < 0.001).
In biopsy GS 9-10 patients, no CSM differences were observed after RP ± aRT vs. EBRT. However, in patients in whom RP did not have to be combined with aRT, RP seems to be associated with a minor improvement in cancer-specific survival compared to EBRT. This applied to the majority of GS 9-10 RP patients.
Gleason 评分（GS）9-10 前列腺癌与特别不利的肿瘤学结果相关，最佳治疗方法尚不清楚。因此，研究了根治性前列腺切除术（RP）±辅助放疗（aRT）与外照射放疗（EBRT）后癌症特异性死亡率（CSM）的差异。
在监测、流行病学和结果数据库（2004-2015 年）中，确定了 17897 名经活检证实为 GS 9-10 的局限性前列腺癌患者，他们接受了 RP±aRT 或 EBRT。在倾向评分匹配后，使用时间趋势、累积发生率图和多变量竞争风险回归分析。根据主要治疗类型（仅 RP 或 EBRT）进行敏感性分析。
所有患者中，8890 例（49.7%）接受 EBRT，9007 例（50.3%）接受 RP。其中，2584 例（28.7%）接受 aRT。随着时间的推移，治疗分配没有明显变化。在累积发生率平滑图中，10 年 CSM 率在 RP 组和 EBRT 组分别为 19.9%和 19.6%（P=0.3），10 年其他原因死亡率分别为 11.5%和 31.2%（P<0.001）。在多变量竞争风险回归分析中，RP 未成为 CSM 降低的独立预测因素（风险比（HR）：0.93，P=0.2）。在仅 RP 与 EBRT 患者的敏感性分析中，RP 是 CSM 降低的独立预测因素（HR：0.76，P<0.001）。
在活检 GS 9-10 患者中，RP±aRT 与 EBRT 后 CSM 无差异。然而，在不需要将 RP 与 aRT 联合使用的患者中，与 EBRT 相比，RP 似乎与癌症特异性生存的轻微改善相关。这适用于大多数 GS 9-10 RP 患者。
