Chen Wei-Kang, Wu Zhi-Gang
Department of andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Transl Androl Urol. 2020 Dec;9(6):2587-2595. doi: 10.21037/tau-20-1044.
Controversial effectiveness of chemotherapy and still poor prognosis prompt us to find better treatment options. This study targeted at investigating whether adding radiotherapy based on chemotherapy can effectively improve the prognosis of patients, especially for advanced penile cancer.
Data were obtained from the Surveillance, Epidemiology, and End Results database (SEER*Stat software V.8.3.5; USA; Accession numbers: 13693-Nov2015 and lh8N79l2), and the survival curves were conducted using the Kaplan-Meier method. Univariate and multivariate cox regression models were performed in order to determine the hazard ratios (HRs) with 95% confidence intervals (CIs) for penile cancer-specific survival (PCSS). Subgroup analysis via multivariate Cox models were conducted to discovery the different effect in population with different features.
The median follow-up time was 25 months, the 2-year PCSS was 52.98% in the chemoradiotherapy group and 55.81% in the chemotherapy group. In multivariate analysis of all patients, combined chemoradiotherapy was not associated with PCSS (HR =0.90, 95% CI: 0.63-1.29, P=0.572). In subgroup analysis, chemoradiotherapy improved the PCSS in N3 patients compared to these patients without therapy of radiotherapy (HR =0.54, 95% CI: 0.30-0.98, P=0.043).
Our study demonstrated a significant correlation of chemoradiotherapy with improved cancer-specific survival of penile cancer (PeCa) in N3 patients. Prospective international multicenter studies are necessary in order to improve prognosis for patients with advanced penile cancer.
化疗效果存在争议且预后仍然较差,这促使我们寻找更好的治疗方案。本研究旨在调查在化疗基础上增加放疗是否能有效改善患者预后,尤其是晚期阴茎癌患者的预后。
数据来自监测、流行病学和最终结果数据库(SEER*Stat软件V.8.3.5;美国; accession编号:13693-Nov2015和lh8N79l2),生存曲线采用Kaplan-Meier法绘制。进行单因素和多因素cox回归模型分析,以确定阴茎癌特异性生存(PCSS)的风险比(HRs)及95%置信区间(CIs)。通过多因素Cox模型进行亚组分析,以发现不同特征人群的不同效果。
中位随访时间为25个月,放化疗组的2年PCSS为52.98%,化疗组为55.81%。在所有患者的多因素分析中,联合放化疗与PCSS无关(HR =0.90,95% CI:0.63-1.29,P=0.572)。亚组分析中,与未接受放疗的患者相比,放化疗改善了N3患者的PCSS(HR =0.54,95% CI:0.30-0.98,P=0.043)。
我们的研究表明,放化疗与N3期阴茎癌患者癌症特异性生存率的提高显著相关。为改善晚期阴茎癌患者的预后,有必要开展前瞻性国际多中心研究。