中危和高危局限性前列腺癌患者行近距离间质放疗联合或不联合雄激素剥夺治疗的比较
I Interstitial brachytherapy with or without androgen deprivation therapy among unfavorable-intermediate and high-risk prostate cancer.
机构信息
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL.
出版信息
Brachytherapy. 2022 Jan-Feb;21(1):85-93. doi: 10.1016/j.brachy.2021.09.001. Epub 2021 Oct 14.
PURPOSE/OBJECTIVE(S): To determine if patients with unfavorable intermediate-risk (UIR), high-risk (HR), or very high-risk (VHR) prostate cancer (PCa) treated with I interstitial brachytherapy benefit from androgen deprivation therapy (ADT).
MATERIALS/METHODS: We reviewed our institutional database of patients with UIR, HR, or VHR PCa, per 2018 NCCN risk classification, treated with definitive I interstitial brachytherapy with or without ADT from 1998-2017. Outcomes including biochemical failure (bF), distant metastases (DM), and overall survival (OS) were analyzed with the Kaplan-Meier method and Cox proportional hazards regression. PCa-specific mortality (PCSM) was analyzed with Fine-Gray competing-risk regression.
RESULTS
Of 1033 patients, 262 (25%) received ADT and 771 (75%) did not. Median ADT duration was 6 months. By risk group, 764 (74%) patients were UIR, 219 (21%) HR, and 50 (5%) VHR. ADT was more frequently given to HR (50%) and VHR (56%) patients compared to UIR (16%; p<0.001), to older patients (p<0.001), corresponding with increasing PSA (p<0.001) and Grade Group (p<0.001). Median follow-up was 4.9 years (0.3-17.6 years). On multivariable analysis accounting for risk group, age, and year of treatment, ADT was not associated with bF, DM, PCSM, or OS (p≥0.05 each).
CONCLUSION
Among patients with UIR, HR, and VHR PCa, the addition of ADT to I interstitial brachytherapy was not associated with improved outcomes, and no subgroup demonstrated benefit. Our findings do not support the use of ADT in combination with I interstitial brachytherapy. Prospective studies are required to elucidate the role of ADT for patients with UIR, HR, and VHR PCa treated with prostate brachytherapy.
目的
确定接受 I 型间质近距离放射治疗的中危不利（UIR）、高危（HR）或极高危（VHR）前列腺癌（PCa）患者是否受益于雄激素剥夺治疗（ADT）。
材料/方法：我们回顾了我们机构的数据库，其中包括 1998 年至 2017 年间按 2018 年 NCCN 风险分类接受 I 型间质近距离放射治疗联合或不联合 ADT 治疗的 UIR、HR 或 VHR PCa 患者。采用 Kaplan-Meier 方法和 Cox 比例风险回归分析生化失败（bF）、远处转移（DM）和总生存（OS）等结果。采用 Fine-Gray 竞争风险回归分析前列腺癌特异性死亡率（PCSM）。
结果
在 1033 名患者中，262 名（25%）接受了 ADT，771 名（75%）未接受 ADT。ADT 的中位持续时间为 6 个月。按风险组，764 名（74%）患者为 UIR，219 名（21%）为 HR，50 名（5%）为 VHR。与 UIR 患者（16%；p<0.001）相比，HR（50%）和 VHR（56%）患者更常接受 ADT，并且与老年患者（p<0.001）和 PSA 逐渐升高（p<0.001）和 Grade Group 逐渐升高（p<0.001）相关。中位随访时间为 4.9 年（0.3-17.6 年）。多变量分析考虑了风险组、年龄和治疗年份，ADT 与 bF、DM、PCSM 或 OS 均无相关性（p≥0.05）。
结论
在 UIR、HR 和 VHR PCa 患者中，I 型间质近距离放射治疗联合 ADT 并未改善结局，且没有亚组显示获益。我们的研究结果不支持将 ADT 联合 I 型间质近距离放射治疗用于治疗 PCa。需要前瞻性研究来阐明 ADT 在接受前列腺近距离放射治疗的 UIR、HR 和 VHR PCa 患者中的作用。
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