Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 Japan.
Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 Japan; Department of Radiology, Tenri Hospital, Tenri-shi, Nara, Japan.
Urol Oncol. 2021 Feb;39(2):131.e9-131.e15. doi: 10.1016/j.urolonc.2020.09.026. Epub 2020 Oct 27.
The aim of this study was to investigate the clinical significance of the effect of age on disease control in men who received high-dose intensity-modulated radiation therapy (IMRT) for nonmetastatic prostate cancer (NMPCa).
NMPCa patients with favorable intermediate to very high-risk features (National Comprehensive Cancer Network risk classification) treated with IMRT at our institution between September 2000 and May 2011 were analyzed retrospectively. Treatment consisted of high-dose IMRT (74-78 Gy/37-39 fractions) combined with 6 months of neoadjuvant hormonal therapy. Multivariable analysis using Fine and Gray's regression model was performed to evaluate whether age at initiation of IMRT was associated with biochemical failure (BF) and castration-resistant prostate cancer (CRPC) progression.
A total of 367 patients were analyzed. The median follow-up period was 8.8 years after IMRT. The 5- and 10-year BF rates were 22.1 and 31.7%, and those of CRPC rates were 4.5 and 12.6%, respectively. Multivariable analysis revealed that a younger age (cut-off: 70 years old) at the initiation of IMRT was significantly correlated with both a higher BF rate (hazard ratio: 1.691, P= 0.0064) and higher CRPC rate (hazard ratio: 2.579, P = 0.0079).
Younger men with NMPCa had increased risks of BF and CRPC after high-dose IMRT, and may benefit from more intensive treatments. Our findings should be further tested in prospective studies.
本研究旨在探讨年龄对接受高强度调强放疗（IMRT）治疗非转移性前列腺癌（NMPCa）男性疾病控制影响的临床意义。
回顾性分析 2000 年 9 月至 2011 年 5 月在我院接受 IMRT 治疗且具有良好中高危特征（国家综合癌症网络风险分类）的 NMPCa 患者。治疗包括高剂量 IMRT（74-78Gy/37-39 次）联合 6 个月新辅助激素治疗。采用 Fine 和 Gray 回归模型进行多变量分析，以评估 IMRT 起始时的年龄是否与生化失败（BF）和去势抵抗性前列腺癌（CRPC）进展相关。
共分析了 367 例患者。IMRT 后中位随访时间为 8.8 年。5 年和 10 年 BF 率分别为 22.1%和 31.7%，CRPC 率分别为 4.5%和 12.6%。多变量分析显示，IMRT 起始时年龄较小（截定点：70 岁）与 BF 率较高（风险比：1.691，P=0.0064）和 CRPC 率较高（风险比：2.579，P=0.0079）显著相关。
NMPCa 年轻男性接受高剂量 IMRT 后 BF 和 CRPC 的风险增加，可能受益于更强化的治疗。我们的发现应在前瞻性研究中进一步验证。
