Liu Mengzhu, Jin Kun, Qiu Shi, Xu Pengyong, Zhang Mingming, Cai Wufeng, Zheng Xiaonan, Yang Lu, Wei Qiang
Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, China.
Asian J Urol. 2021 Apr;8(2):227-234. doi: 10.1016/j.ajur.2020.05.005. Epub 2020 May 23.
To evaluate the oncological outcomes of ductal adenocarcinoma of the prostate (DAC) managed with radical prostatectomy (RP) or radiotherapy (RT) and optimize the proper treatment modality to DAC comprehensively.
The cohorts included a total of 528 patients from the Surveillance, Epidemiology and End Results (SEER) database, 354 receiving RP and 174 receiving RT. Cox proportional hazards regressions were performed to assess cancer specific mortality (CSM) and overall mortality (OM) between treatment groups. A competing risk analysis was further conducted. Subgroup analyses by age and level of prostate-specific antigen (PSA) were performed. Propensity score matching was implemented.
Patients managed with RP had lower risks of CSM and OM compared with RT (before matching: Hazard ratio [HR]=0.24, 95% confidence interval [CI] 0.13-0.47 and HR=0.26, 95% CI 0.17-0.40, respectively; after matching: HR=0.18, 95% CI 0.04-0.82 and HR=0.28, 95% CI 0.11-0.70, accordingly). Subgroup analyses demonstrated that patients in the middle tertile of the age or with lower tertile PSA level managed with RP took lower risks of OM significantly (HR=0.18, 95% CI 0.06-0.57, <0.01 and HR=0.17, 95% CI 0.06-0.54, <0.01).
Among patients with DAC, treatment with RP was associated with better survival outcomes in comparison with RT. Patients with DAC in the middle tertile of the age and with lower tertile PSA level benefited the most from RP.
评估采用根治性前列腺切除术（RP）或放射治疗（RT）治疗前列腺导管腺癌（DAC）的肿瘤学结局，并全面优化DAC的合适治疗方式。
该队列共纳入来自监测、流行病学和最终结果（SEER）数据库的528例患者，其中354例接受RP治疗，174例接受RT治疗。进行Cox比例风险回归分析以评估治疗组之间的癌症特异性死亡率（CSM）和总死亡率（OM）。进一步进行竞争风险分析。按年龄和前列腺特异性抗原（PSA）水平进行亚组分析。实施倾向得分匹配。
与RT相比，接受RP治疗的患者CSM和OM风险更低（匹配前：风险比[HR]=0.24，95%置信区间[CI]为0.13 - 0.47；HR=0.26，95%CI为0.17 - 0.40；匹配后：HR=0.18, 95%CI为0.04 - 0.82；HR=0.28, 95%CI为0.11 - 0.70）。亚组分析表明，年龄处于中间三分位数或PSA水平处于较低三分位数且接受RP治疗的患者OM风险显著更低（HR=0.18，95%CI为0.06 - 0.57，<0.01；HR=0.17，95%CI为0.06 - 0.54，<0.01）。
在DAC患者中，与RT相比，RP治疗与更好的生存结局相关。年龄处于中间三分位数且PSA水平处于较低三分位数的DAC患者从RP治疗中获益最大。
