Hasan Shaakir, Gorovets Daniel, Lehrer Eric, Lazarev Stanislav, Press Robert H, Garg Madhur, Mehta Keyur J, Chhabra Arpit M, Isabelle Choi J, Simone Charles B
New York Proton Center, New York, NY, USA.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Clin Transl Radiat Oncol. 2020 Nov 25;26:47-54. doi: 10.1016/j.ctro.2020.11.006. eCollection 2021 Jan.
High-risk prostate cancer is associated with poorer overall survival (OS) and biochemical control compared to more favorable risk groups. External beam radiation therapy (EBRT) is widely used; however, outcomes data are limited with respect to time elapsed between diagnosis and initiation of EBRT.
The National Cancer Database was queried from 2004 to 2015 for patients diagnosed with high-risk adenocarcinoma of the prostate who received androgen deprivation therapy (ADT) and definitive EBRT. Logistic regression was utilized to determine covariates associated with missing EBRT treatments. OS was analyzed using multivariate cox proportional hazards models and propensity score matching.
9,610 patients met inclusion criteria with median follow-up of 40.6 months and median age of 72 years. Median PSA was 8.7 and median EBRT dose was 78 Gy. ADT was initiated at a median of 36 days and EBRT at a median of 63 days post-diagnosis. Median number of prolonged treatment days was 2.2. Black race (OR: 1.40; < 0.01), treatment at a community clinic (OR: 1.32; p < 0.01), and living in an urban/densely populated area were associated with prolonged treatment. Time elapsed between ADT and EBRT > 74 days (HR: 1.20; = 0.01) and prolonged treatment>3 days of EBRT (HR: 1.26; = 0.005) were associated with an increased hazard of death. The 5-year OS was 79.6% and 82.9% for patients with prolonged treatment of 3 days or more of EBRT and those missing 3 days or less, respectively ( = 0.0006).
In this hypothesis-generating study, prolonged treatment delays and missing three or more EBRT treatments was associated with poorer OS in patients with high-risk adenocarcinoma of the prostate.
与风险较低的前列腺癌患者相比，高危前列腺癌患者的总生存期（OS）和生化控制情况较差。外照射放疗（EBRT）被广泛应用；然而，关于诊断与EBRT开始之间的时间间隔的结局数据有限。
查询2004年至2015年的国家癌症数据库，纳入诊断为高危前列腺腺癌且接受雄激素剥夺治疗（ADT）和确定性EBRT的患者。采用逻辑回归确定与错过EBRT治疗相关的协变量。使用多变量Cox比例风险模型和倾向评分匹配分析总生存期。
9610例患者符合纳入标准，中位随访时间为40.6个月，中位年龄为72岁。中位前列腺特异性抗原（PSA）为8.7，中位EBRT剂量为78Gy。ADT在诊断后中位36天开始，EBRT在诊断后中位63天开始。延长治疗天数的中位数为2.2天。黑人种族（比值比[OR]：1.40；P<0.01）、在社区诊所接受治疗（OR：1.32；P<0.01）以及生活在城市/人口密集地区与治疗延长有关。ADT与EBRT之间的时间间隔>74天（风险比[HR]：1.20；P=0.01）以及EBRT延长治疗>3天（HR：1.26；P=0.005）与死亡风险增加有关。EBRT延长治疗3天或更长时间的患者和错过3天或更短时间的患者的5年总生存率分别为79.6%和82.9%（P=0.0006）。
在这项产生假设的研究中，高危前列腺腺癌患者治疗延迟延长以及错过三次或更多次EBRT治疗与较差的总生存期相关。
