Guo Xiao-Xiao, Xia Hao-Ran, Hou Hui-Min, Liu Ming, Wang Jian-Ye
Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China.
Front Oncol. 2021 Jul 19;11:708373. doi: 10.3389/fonc.2021.708373. eCollection 2021.
We aimed compare the oncologic outcomes of radical prostatectomy (RP) with those of external beam radiotherapy (EBRT), brachytherapy (BT), or EBRT + BT (EBBT) in elderly patients with localised prostate cancer (PCa).
Localised PCa patients aged ≥70 years who underwent RP, EBRT, BT, or EBBT between 2004 and 2016 were identified from the Surveillance, Epidemiology, and End Results database. Multivariable competing risks survival analyses were used to estimate prostate cancer-specific mortality (CSM) and other-cause mortality (OCM). Subgroup analyses according to risk categories were also conducted.
Overall, 14057, 37712, 8383, and 5244 patients aged ≥70 years and treated with RP, EBRT, BT, and EBBT, respectively, were identified. In low- to intermediate-risk patients, there was no significant difference in CSM risk between RP and the other three radiotherapy modalities (all P > 0.05). The corresponding 10-year CSM rates for these patients were 1.2%, 2.3%, 2.0%, and 1.8%, respectively. In high-risk patients, EBRT was associated with a higher CSM than RP (P = 0.003), whereas there was no significant difference between RP and BT or RP and EBBT (all P > 0.05). The 10-year CSM rates of high-risk patients in the RP, EBRT, BT, and EBBT groups were 7.5%, 10.2%, 8.3%, and 7.6%, respectively. Regarding OCM, the risk was generally lower in RP than in the other three radiotherapy modalities (all P < 0.001).
Among men aged ≥70 years with localised PCa, EBRT, BT, and EBBT offer cancer-specific outcomes similar to those of RP for individuals with low- to intermediate-risk disease. In patients with high-risk disease, EBBT had outcomes equally favourable to those of RP, but RP is more beneficial than EBRT. More high-quality trials are warranted to confirm and expand the present findings.
我们旨在比较根治性前列腺切除术（RP）与外照射放疗（EBRT）、近距离放疗（BT）或EBRT+BT（EBBT）对老年局限性前列腺癌（PCa）患者的肿瘤学结局。
从监测、流行病学和最终结果数据库中识别出2004年至2016年间接受RP、EBRT、BT或EBBT治疗的年龄≥70岁的局限性PCa患者。采用多变量竞争风险生存分析来估计前列腺癌特异性死亡率（CSM）和其他原因死亡率（OCM）。还根据风险类别进行了亚组分析。
总体而言，分别识别出14057例、37712例、8383例和5244例年龄≥70岁且接受RP、EBRT、BT和EBBT治疗的患者。在低至中度风险患者中，RP与其他三种放疗方式之间的CSM风险无显著差异（所有P>0.05）。这些患者相应的10年CSM率分别为1.2%、2.3%、2.0%和1.8%。在高风险患者中，EBRT的CSM高于RP（P=0.003），而RP与BT或RP与EBBT之间无显著差异（所有P>0.05）。RP、EBRT、BT和EBBT组高风险患者的10年CSM率分别为7.5%、10.2%、8.3%和7.6%。关于OCM，RP的风险通常低于其他三种放疗方式（所有P<0.001）。
在年龄≥70岁的局限性PCa男性中，对于低至中度风险疾病患者，EBRT、BT和EBBT的癌症特异性结局与RP相似。在高风险疾病患者中，EBBT的结局与RP同样良好，但RP比EBRT更有益。需要更多高质量试验来证实和扩展目前的发现。
