Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan, USA.
Can J Urol. 2020 Apr;27(2):10154-10161.
In addition to survival endpoints, we explored the impact of Charlson Comorbidity-Index (CCI) on the acute and late toxicities in men with localized prostate cancer who received dose-escalated definitive radiotherapy (RT).
CCI scores at diagnosis and survival outcomes were identified for men with intermediate/high-risk prostate cancer treated with RT (1/2007-12/2012). Study-cohort was accordingly grouped into no, mild and severe comorbidity (CCI-0, 1 or 2+). CCI-groups were compared for demographics, prognostic-factors; and RT-related toxicities based on RTOG/CTCAE criteria. Kaplan-Meier curves and Uni/multivariate (MVA) analyses were used to examine the influence of CCI-group on overall (OS), disease-specific (DSS) and biochemical-relapse free (BRFS) survival.
We included 257 patients with median age 73 years (48-85), 53% African-American and 67% had intermediate-risk. Median prostate RT-dose was 76 Gy; and 47% received androgen-deprivation therapy. CCI-0,1,2+ groups encompassed 76 (30%), 54 (21%) and 127 (49%) patients, respectively and were well-balanced. Ten and 15-years OS were significantly different (76% versus 46% versus 55% for 10-years OS and 53% versus 31% versus 14% for 15-years OS for CCI-0 versus CCI-1[HR:2.25; CI[1.31-3.87]] versus CCI-2+[HR:2.73; CI[1.73-4.31]]; p < 0.001. CCI-0 had better DSS than CCI-2+ (HR:2.23; CI[1.06-4.68]; p = 0.03) and BRFS was similar (p = 0.99). Late G2/3 RT-toxicities were more common in CCI-2+ (47%) than CCI-1 (44%) and CCI-0 (29%), p = 0.032; with non-different acute-toxicities (p = 0.62). On MVA, increased CCI was deterministic for OS (HR:3.65; CI [1.71:7.79]; p < 0.001) and was only marginal for DSS (HR:2.55; CI [0.98-6.6]; p = 0.05) with no impact on BRFS (p > 0.05).
Higher CCI is a significant predictor for late RT-related side-effects and shorter OS in men with localized prostate cancer. Baseline comorbidities should be considered during initial counseling and follow up visits.
除了生存终点外，我们还探讨了 Charlson 合并症指数（CCI）对接受剂量递增根治性放疗（RT）的局限性前列腺癌男性的急性和晚期毒性的影响。
确定了接受 RT（2007 年 1 月至 2012 年 12 月）治疗的中高危前列腺癌男性的 CCI 评分和生存结果。根据研究队列，将患者分为无、轻度和重度合并症（CCI-0、1 或 2+）。根据 RTOG/CTCAE 标准，比较 CCI 组之间的人口统计学、预后因素和 RT 相关毒性。使用 Kaplan-Meier 曲线和单/多变量（MVA）分析检查 CCI 组对总生存（OS）、疾病特异性生存（DSS）和生化无复发生存（BRFS）的影响。
我们纳入了 257 名中位年龄为 73 岁（48-85 岁）的患者，其中 53%为非裔美国人，67%为中危患者。中位前列腺 RT 剂量为 76 Gy；47%接受雄激素剥夺治疗。CCI-0、1、2+组分别包括 76 名（30%）、54 名（21%）和 127 名（49%）患者，且平衡良好。10 年和 15 年 OS 差异显著（10 年 OS 时，CCI-0 组为 76%，CCI-1 组为 46%，CCI-2+组为 55%；15 年 OS 时，CCI-0 组为 53%，CCI-1 组为 31%，CCI-2+组为 14%；CCI-0 组与 CCI-1[HR：2.25；CI[1.31-3.87]]相比，CCI-2+[HR：2.73；CI[1.73-4.31]]；p<0.001）。CCI-0 的 DSS 优于 CCI-2+（HR：2.23；CI[1.06-4.68]；p=0.03），BRFS 相似（p=0.99）。CCI-2+（47%）比 CCI-1（44%）和 CCI-0（29%）更常见晚期 G2/3 RT 毒性，p=0.032；急性毒性无差异（p=0.62）。在 MVA 中，CCI 升高是 OS（HR：3.65；CI[1.71:7.79]；p<0.001）的显著预测因子，对 DSS 仅为边缘预测因子（HR：2.55；CI[0.98-6.6]；p=0.05），对 BRFS 无影响（p>0.05）。
在局限性前列腺癌患者中，较高的 CCI 是晚期 RT 相关副作用和较短 OS 的重要预测因子。在初始咨询和随访期间应考虑基线合并症。
