Ghabili Kamyar, Park Henry S, Yu James B, Sprenkle Preston C, Kim Simon P, Nguyen Kevin A, Ma Xiaomei, Gross Cary P, Leapman Michael S
Department of Urology, Yale School of Medicine, 789 Howard Avenue, FMP 300, New Haven, CT, 06520, USA.
Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
World J Urol. 2021 Apr;39(4):1141-1151. doi: 10.1007/s00345-020-03298-6. Epub 2020 Jun 19.
To evaluate practice patterns of planned post-operative radiation therapy (RT) among men with positive surgical margins (PSM) at radical prostatectomy.
We identified 43,806 men within the National Cancer Database with pathologic node-negative prostate cancer diagnosed in 2010 through 2014 with PSM. The primary endpoint was receipt of planned (RT) within a patient's initial course of treatment. We examined post-RP androgen deprivation therapy (ADT) with RT as a secondary endpoint. We evaluated patterns of post-operative management and characteristics associated with planned post-prostatectomy RT.
Within 12 months of RP, 87.0% received no planned RT, 8.5% RT alone, 1.3% ADT alone, and 3.1% RT with ADT. In a multivariable logistic regression model, planned RT use was associated with clinical and pathologic characteristics as estimated by surgical Cancer of the Prostate Risk Assessment (CAPRA-S) category (intermediate versus low, OR = 2.87, 95% CI 2.19-3.75, P < 0.001; high versus low, OR = 10.23, 95% CI 7.79-13.43, P < 0.001), treatment at community versus academic centers (OR = 1.24, 95% CI 1.15-1.34, P < 0.001), shorter distance to a treatment facility (OR = 0.97 for each 10-mile, 95% CI 0.96-0.98, P < 0.001), and uninsured status (OR = 1.39, 95% CI 1.10-1.77, P = 0.005). The odds of receiving planned RT were lower in 2014 versus 2010 (OR = 0.76, 95% CI 0.68-0.85, P < 0.001). There was no significant change in the use of ADT with RT. High versus low CAPRA-S category was associated with the use of ADT in addition to RT (OR = 5.13, 95% CI 1.57-16.80, P = 0.007).
The use of planned post-prostatectomy RT remained stable among patients with PSM and appears driven primarily by the presence of other adverse pathologic features.
评估根治性前列腺切除术后手术切缘阳性（PSM）男性患者的计划性术后放疗（RT）实践模式。
我们在国家癌症数据库中识别出43806例在2010年至2014年期间被诊断为病理淋巴结阴性前列腺癌且伴有PSM的男性患者。主要终点是患者在初始治疗过程中接受计划性（RT）的情况。我们将RP后雄激素剥夺治疗（ADT）联合RT作为次要终点进行研究。我们评估了术后管理模式以及与计划性前列腺切除术后RT相关的特征。
在RP后的12个月内，87.0%的患者未接受计划性RT，8.5%仅接受RT，1.3%仅接受ADT，3.1%接受RT联合ADT。在多变量逻辑回归模型中，计划性RT的使用与临床和病理特征相关，这些特征通过手术前列腺癌风险评估（CAPRA-S）类别进行估计（中等风险与低风险相比，OR = 2.87，95%CI 2.19 - 3.75，P < 0.001；高风险与低风险相比，OR = 10.23，95%CI 7.79 - 13.43，P < 0.001），社区与学术中心的治疗情况（OR = 1.24，95%CI 1.15 - 1.34，P < 0.001），到治疗机构的距离较短（每10英里OR = 0.97，95%CI 0.96 - 0.98，P < 0.001），以及未参保状态（OR = 一点三九，95%CI 1.10 - 1.77，P = 0.005）。2014年接受计划性RT的几率低于2010年（OR = 0.76，95%CI 0.68 - 0.85，P < 0.001）。RT联合ADT的使用没有显著变化。高CAPRA-S类别与低CAPRA-S类别相比，除RT外还与ADT的使用相关（OR = 5.一三，95%CI 1.57 - 16.80，P = 0.007）。
PSM患者中计划性前列腺切除术后RT的使用保持稳定，且似乎主要由其他不良病理特征的存在所驱动。
