Choi Seo Hee, Kim Young Seok, Yu Jesang, Nam Taek-Keun, Kim Jae-Sung, Jang Bum-Sup, Kim Jin Ho, Kim Youngkyong, Jung Bae Kwon, Chang Ah Ram, Park Young-Hee, Lee Sung Uk, Cho Kwan Ho, Kim Jin Hee, Kim Hunjung, Choi Youngmin, Kim Yeon Joo, Lee Dong Soo, Shin Young Ju, Shim Su Jung, Park Won, Cho Jaeho
Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea.
Yonsei Cancer Center, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 03722, Korea.
Cancers (Basel). 2021 May 31;13(11):2732. doi: 10.3390/cancers13112732.
This nationwide multi-institutional study analyzed the patterns of care and outcomes of external beam radiotherapy (EBRT) in localized prostate cancer patients. We compared various risk classification tools and assessed the need for refinements in current radiotherapy (RT) schemes.
We included non-metastatic prostate cancer patients treated with primary EBRT from 2001 to 2015 in this study. Data of 1573 patients from 17 institutions were analyzed and re-grouped using a risk stratification tool with the highest predictive power for biochemical failure-free survival (BCFFS). We evaluated BCFFS, overall survival (OS), and toxicity rates.
With a median follow-up of 75 months, 5- and 10-year BCFFS rates were 82% and 60%, and 5- and 10-year OS rates were 95% and 83%, respectively. NCCN risk classification revealed the highest predictive power (AUC = 0.556, 95% CI 0.524-0.588; < 0.001). Gleason score, iPSA < 12 ng/mL, intensity-modulated RT (IMRT), and ≥179 Gy (EQD2, 77 Gy) were independently significant for BCFFS (all < 0.05). IMRT and ≥179 Gy were significant factors in the high-risk group, whereas ≥170 Gy (EQD2, 72 Gy) was significant in the intermediate-risk group and no significant impact of dose was observed in the low-risk group. Both BCFFS and OS improved significantly when ≥179 Gy was delivered using IMRT and hypofractionation in the high-risk group without increasing toxicities.
With NCCN risk classification, dose escalation with modern high-precision techniques might increase survivals in the high-risk group, but not in the low-risk group, although mature results of prospective studies are awaited.
这项全国性多机构研究分析了局限性前列腺癌患者的外照射放疗（EBRT）治疗模式及疗效。我们比较了各种风险分类工具，并评估了当前放疗（RT）方案改进的必要性。
本研究纳入了2001年至2015年接受原发性EBRT治疗的非转移性前列腺癌患者。分析了来自17家机构的1573例患者的数据，并使用对无生化复发生存（BCFFS）具有最高预测能力的风险分层工具进行重新分组。我们评估了BCFFS、总生存（OS）和毒性发生率。
中位随访75个月，5年和10年BCFFS率分别为82%和60%，5年和10年OS率分别为95%和83%。NCCN风险分类显示出最高的预测能力（AUC = 0.556，95% CI 0.524 - 0.588；P < 0.001）。Gleason评分、初始前列腺特异抗原（iPSA）< 12 ng/mL、调强放疗（IMRT）以及≥179 Gy（等效剂量2，77 Gy）对BCFFS具有独立显著意义（均P < 0.05）。IMRT和≥179 Gy是高危组的显著因素，而≥170 Gy（等效剂量2，72 Gy）在中危组具有显著意义，在低危组未观察到剂量的显著影响。在高危组中，当使用IMRT和大分割放疗给予≥179 Gy时，BCFFS和OS均显著改善，且未增加毒性。
采用NCCN风险分类，尽管前瞻性研究的成熟结果尚待期待，但使用现代高精度技术进行剂量递增可能会提高高危组的生存率，而低危组则不然。
