Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China,
The Clinical Medical College of Lanzhou University, Lanzhou, China.
Urol Int. 2022;106(1):11-19. doi: 10.1159/000518113. Epub 2021 Aug 26.
The aim of this study was to evaluate the survival outcomes of radical prostatectomy (RP), external beam radiotherapy plus brachytherapy (EBRT + BT), and EBRT alone among elderly men (aged 70 years and above) with very high-risk (VHR) prostate cancer (PCa).
We identified elderly men diagnosed with VHR PCa between 2004 and 2015 in the Surveillance, Epidemiology, and End Results database. The propensity score-matching method was adopted to balance the covariates and generate new cohorts. -Kaplan-Meier and Cox analyses were conducted to build up survival curves and evaluate the overall survival (OS) and PCa-specific survival (PCSS) outcomes.
A total of 9,818 patients were identified. Of them, 5,839 were in the EBRT group, 725 in the EBRT + BT group, and 3,254 in the RP group. The survival curves of the overall cohort showed that RP was associated with the best OS, followed by EBRT + BT and EBRT (p < 0.001). As for the PCSS, RP shared similar outcomes with EBRT + BT (hazard ratio [HR]: 1.25 [0.93-1.69], p = 0.175). EBRT was associated with significantly worse PCSS than both RP (HR: 1.88, 95% confidence interval [95% CI] [1.64-2.15], p < 0.001) and EBRT + BT (HR: 1.48, 95% CI [1.19-1.85], p = 0.002). In the matched cohorts, RP presented better OS (HR: 1.41, 95% CI [1.07-1.86], p = 0.041) and similar PCSS with EBRT + BT (HR: 1.50, 95% CI [0.91-2.47], p = 0.12). RP was associated with significantly better OS and PCSS outcomes than EBRT alone (OS HR: 1.58, 95% CI [1.59-2.12], p < 0.001; PCSS HR: 2.08 [1.60-2.72], p < 0.001). EBRT + BT also had significantly better OS and PCSS outcomes than EBRT alone (OS HR: 1.33, 95% CI [1.11-1.60], p < 0.001; PCSS HR: 1.57 [1.13-2.19], p = 0.003).
For patients above 70 years with VHR PCa, RP was associated with better OS and similar PCSS than EBRT + BT. Both RP and EBRT + BT have better OS and PCSS than EBRT alone.
本研究旨在评估高龄（≥70 岁）极高危（VHR）前列腺癌（PCa）患者接受根治性前列腺切除术（RP）、外照射放疗联合近距离放疗（EBRT + BT）和单纯 EBRT 治疗的生存结局。
我们在 Surveillance, Epidemiology, and End Results 数据库中确定了 2004 年至 2015 年间被诊断为 VHR PCa 的高龄男性患者。采用倾向评分匹配法平衡协变量并生成新的队列。通过 Kaplan-Meier 和 Cox 分析构建生存曲线，并评估总生存（OS）和 PCa 特异性生存（PCSS）结局。
共纳入 9818 例患者。其中，5839 例接受 EBRT 治疗，725 例接受 EBRT + BT 治疗，3254 例接受 RP 治疗。全队列的生存曲线显示，RP 与最佳 OS 相关，其次是 EBRT + BT 和 EBRT（p<0.001）。对于 PCSS，RP 与 EBRT + BT 具有相似的结局（风险比 [HR]：1.25 [0.93-1.69]，p=0.175）。与 RP 和 EBRT + BT 相比，EBRT 与明显较差的 PCSS 相关（HR：1.88，95%置信区间 [95%CI] [1.64-2.15]，p<0.001）和 EBRT + BT（HR：1.48，95%CI [1.19-1.85]，p=0.002）。在匹配队列中，RP 具有更好的 OS（HR：1.41，95%CI [1.07-1.86]，p=0.041）和与 EBRT + BT 相似的 PCSS（HR：1.50，95%CI [0.91-2.47]，p=0.12）。与单纯 EBRT 相比，RP 与更好的 OS 和 PCSS 结局相关（OS HR：1.58，95%CI [1.59-2.12]，p<0.001；PCSS HR：2.08 [1.60-2.72]，p<0.001）。EBRT + BT 与单纯 EBRT 相比，OS 和 PCSS 结局也更好（OS HR：1.33，95%CI [1.11-1.60]，p<0.001；PCSS HR：1.57 [1.13-2.19]，p=0.003）。
对于 VHR PCa 年龄≥70 岁的患者，RP 与 EBRT + BT 相比，OS 更好，PCSS 相似。RP 和 EBRT + BT 与单纯 EBRT 相比，OS 和 PCSS 更好。
