Wang Yan, Song Pan, Wang Jiaxiang, Shu Mengxuan, Wang Qingwei, Li Qi
Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
Department of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China.
J Cancer. 2020 Jul 11;11(18):5371-5378. doi: 10.7150/jca.46069. eCollection 2020.
To evaluate the survival difference of radical prostatectomy (RP) and external beam radiotherapy (EBRT) in elderly men (75 years and older) with high-risk (HR) or very high-risk (VHR) prostate cancer (PCa). Elderly men diagnosed with HR/VHR PCa from 2004-2015 in the Surveillance, Epidemiology and End Results (SEER) database were identified. Propensity-score matching (PSM) was conducted to balance the covariates; Kaplan-Meier and Cox analysis were performed to evaluate the overall survival (OS) and prostate cancer-specific survival (PCSS). 11698 patients with HR PCa and 4415 patients with VHR PCa were identified and divided into RP and EBRT group. After PSM, 964 patients with HR PCa and 538 patients with VHR PCa were included in each group. The 10-year OS and PCSS of men with HR PCa were 60.1% vs 40.9% and 90.6% vs 83.4%, respectively. The 10-year rate of OS and PCSS in men with VHR PCa were 55.9% vs 33.3% and 82.4% vs 75.6%, respectively. The OS curve of patients with HR PCa revealed that RP was significantly better than EBRT in both overall cohort [HR: 0.533, 95%CI (0.4850.586), p<0.001] and the matched cohort [HR: 0.703, 95%CI (0.5950.832), p<0.001]. However, the PCSS curve of patients with HR PCa showed that RP was significantly better than EBRT in overall cohort [HR: 0.453, 95%CI (0.3680.559), p<0.001] but was similar to EBRT in matched cohort [HR: 0.820, 95%CI (0.5521.218), p=0.327]. As for patients with VHR PCa, RP was associated with better OS than EBRT whether in overall cohort [HR: 0.520, 95%CI (0.4570.592), p<0.001] or matched cohort [0.695, 95%CI (0.5510.876), p=0.002]. The PCSS of RP was significantly better than that of EBRT in overall cohort [HR: 0.538, 95%CI (0.422~ 0.685), p<0.001], but was similar in matched cohort [HR: 0.787, 95%CI (0.510 ~1.214), p=0.281]. RP has more survival benefits than EBRT in men aged 75 years and older with HR or VHR PCa.
评估根治性前列腺切除术（RP）与外照射放疗（EBRT）对75岁及以上高危（HR）或极高危（VHR）前列腺癌（PCa）老年男性患者生存差异。从监测、流行病学和最终结果（SEER）数据库中确定2004年至2015年诊断为HR/VHR PCa的老年男性。进行倾向评分匹配（PSM）以平衡协变量；采用Kaplan-Meier和Cox分析评估总生存期（OS）和前列腺癌特异性生存期（PCSS）。共识别出11698例HR PCa患者和4415例VHR PCa患者，并分为RP组和EBRT组。PSM后，每组纳入964例HR PCa患者和538例VHR PCa患者。HR PCa男性患者的10年OS率和PCSS率分别为60.1%对40.9%和90.6%对83.4%。VHR PCa男性患者的10年OS率和PCSS率分别为55.9%对33.3%和82.4%对75.6%。HR PCa患者的OS曲线显示，无论是在总体队列[HR：0.533，95%CI（0.4850.586），p<0.001]还是匹配队列[HR：0.703，95%CI（0.5950.832），p<0.001]中，RP均显著优于EBRT。然而，HR PCa患者的PCSS曲线显示，在总体队列中RP显著优于EBRT[HR：0.453，95%CI（0.3680.559），p<0.001]，但在匹配队列中与EBRT相似[HR：0.820，95%CI（0.5521.218），p=0.327]。对于VHR PCa患者，无论在总体队列[HR：0.520，95%CI（0.4570.592），p<0.001]还是匹配队列[0.695，95%CI（0.5510.876），p=0.002]中，RP的OS均优于EBRT。在总体队列中，RP的PCSS显著优于EBRT[HR：0.538，95%CI（0.4220.685），p<0.001]，但在匹配队列中相似[HR：0.787，95%CI（0.5101.214），p=0.281]。对于75岁及以上患有HR或VHR PCa的男性，RP比EBRT具有更多的生存益处。
