减瘤性根治性前列腺切除术在新诊断的低容量转移性前列腺癌治疗中的作用。转移性前列腺癌局部治疗（LoMP）登记研究的结果。
The Role of Cytoreductive Radical Prostatectomy in the Treatment of Newly Diagnosed Low-volume Metastatic Prostate Cancer. Results from the Local Treatment of Metastatic Prostate Cancer (LoMP) Registry.
作者信息
Lumen Nicolaas, De Bleser Elise, Buelens Sarah, Verla Wesley, Poelaert Filip, Claeys Wietse, Fonteyne Valérie, Verbeke Sofie, Villeirs Geert, De Man Kathia, Rottey Sylvie, Van Praet Charles, Decaestecker Karel, Ost Piet
机构信息
Department of Urology, Ghent University Hospital, Ghent, Belgium.
Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
出版信息
Eur Urol Open Sci. 2021 Jun 5;29:68-76. doi: 10.1016/j.euros.2021.05.006. eCollection 2021 Jul.
BACKGROUND
Radiotherapy to the prostate (RTp) prolongs survival for patients with low-volume, newly diagnosed metastatic prostate cancer (ndmPC).
OBJECTIVE
to evaluate whether cytoreductive radical prostatectomy (cRP) is equally beneficial as RTp in low-volume ndmPC.
DESIGN SETTING AND PARTICIPANTS
A multicenter prospective registry was established in 2014 to observe patients with ndmPC. Eligible patients were offered cRP or RTp. For this study we selected only patients with low-volume ndmPC ( = 109). Of these, 48, 26, and 35 patients underwent cRP, RTp, and no local therapy (NLT), respectively. Median follow-up was 32 mo (interquartile range 16-49).
INTERVENTION
cRP was compared with RTp and NLT.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Overall survival (OS), cancer-specific survival (CSS), and local event-free survival (LEFS) were calculated using the Kaplan-Meier method. Factors prognostic for OS were identified using univariate and multivariate Cox regression analysis.
RESULTS AND LIMITATIONS
The 2-yr OS was 93%, 100%, and 69%, and 2-yr CSS was 93%, 100%, and 75% for cRP, RTp, and NLT, respectively. The cRP and RTp groups had better OS compared to NLT and there was no significant difference between cRP and RTp. The 2-yr LEFS was 92%, 77%, and 60% for cRP, RTp, and NLT, respectively. The cRP group had better LEFS compared to RTp and NLT, and there was no significant difference between RTp and NLT. Advanced tumor stage, Eastern Cooperative Oncology Group performance status ≥2, and NLT were negative prognostic factors for OS. The main limitation is selection of fitter patients with less advanced tumors for cRP and the small sample size.
CONCLUSIONS
For selected patients with low-volume ndmPC, cRP is able to achieve similar OS and CSS to RTp. cRP is effective in preventing local events due to disease progression.
PATIENT SUMMARY
Patients with a low volume of newly diagnosed prostate cancer that has spread beyond the prostate gland might benefit from removal of the prostate, which we found was as effective as radiotherapy to the prostate in prolonging survival. Removal of the prostate is effective in preventing urinary problems caused by cancer progression.
背景
对低瘤负荷、新诊断的转移性前列腺癌（ndmPC）患者进行前列腺放疗（RTp）可延长生存期。
目的
评估减瘤性根治性前列腺切除术（cRP）在低瘤负荷ndmPC患者中是否与RTp同样有益。
设计、地点和参与者：2014年建立了一个多中心前瞻性登记处，以观察ndmPC患者。符合条件的患者可选择cRP或RTp。在本研究中，我们仅选择了低瘤负荷ndmPC患者（n = 109）。其中，分别有48例、26例和35例患者接受了cRP、RTp和未进行局部治疗（NLT）。中位随访时间为32个月（四分位间距16 - 49）。
干预措施
将cRP与RTp和NLT进行比较。
结果测量和统计分析
采用Kaplan-Meier方法计算总生存期（OS）、癌症特异性生存期（CSS）和局部无事件生存期（LEFS）。使用单因素和多因素Cox回归分析确定OS的预后因素。
结果与局限性
cRP、RTp和NLT组的2年OS分别为93%、100%和69%，2年CSS分别为93%、100%和75%。与NLT相比，cRP和RTp组的OS更好，且cRP和RTp之间无显著差异。cRP、RTp和NLT组的2年LEFS分别为92%、77%和60%。与RTp和NLT相比，cRP组的LEFS更好，且RTp和NLT之间无显著差异。肿瘤晚期、东部肿瘤协作组体能状态≥2以及NLT是OS的负面预后因素。主要局限性在于为cRP选择了病情较轻、身体状况较好的患者，且样本量较小。
结论
对于选定的低瘤负荷ndmPC患者，cRP能够实现与RTp相似的OS和CSS。cRP在预防因疾病进展导致的局部事件方面有效。
患者总结
新诊断的前列腺癌已扩散至前列腺外且瘤负荷低的患者可能从前列腺切除术中获益，我们发现这在延长生存期方面与前列腺放疗同样有效。前列腺切除术在预防癌症进展引起的泌尿系统问题方面有效。
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