Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO.
Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO.
Brachytherapy. 2022 May-Jun;21(3):317-324. doi: 10.1016/j.brachy.2021.12.008. Epub 2022 Feb 3.
Definitive treatment options for unfavorable intermediate-risk prostate cancer (UIR-PCa) include external beam radiotherapy (EBRT) ± brachytherapy boost ± androgen deprivation therapy (ADT). The role of brachytherapy ± ADT in the absence of EBRT is not well defined. We hypothesized that EBRT+BT±ADT is associated with improved overall survival (OS) relative to BT±ADT for UIR-PCa.
Men with UIR-PCa diagnosed between 2004 and 2015 were identified in the National Cancer Database (NCDB). Inverse propensity of treatment weighting was used to balance covariables that influenced treatment allocation and outcomes, and propensity-weighted multivariable analysis (MVA) using Cox regression modeling was used to compare OS hazard ratios.
A total of 11,721 men were stratified into four treatment groups: (1) BT without ADT (n = 4,535), (2) BT+ADT (n = 1,303), (3) EBRT+BT (n = 3,446), or (4) EBRT+BT+ADT (n = 2,437). Relative to patients treated with BT alone, BT+ADT (Hazard Ratio (HR): 0.86 [95% Confidence Interval (CI): 0.76-0.99], p = 0.03), EBRT+BT (HR: 0.79 [0.70-0.88], p = 0.00002), and EBRT+BT+ADT (HR: 0.76 [0.67-0.85], p = 0.000003) were associated with improved OS on MVA. Relative to BT alone, EBRT+BT correlated with improved OS on weight-adjusted MVA (HR: 0.82 [0.75-0.89], p = 0.000005). 10-year OS for BT vs. EBRT+BT was 62.4% [60.1-64.7] vs. 69.3% [67.5-71.2], respectively (p < 0.0001).
EBRT+BT correlated with improved OS relative to BT alone in men with UIR-PCa, reaffirming current NCCN recommendations recommending EBRT+BT over BT alone. While prior studies reported no benefit to adding EBRT to BT with optimal implant dosimetry, this study suggests men benefit from EBRT in a population of variable implant quality.
中危前列腺癌（UIR-PCa）的明确治疗方案包括外照射放疗（EBRT）±近距离放疗（BT）±雄激素剥夺治疗（ADT）。EBRT 缺失时 BT±ADT 的作用尚未明确。我们假设 EBRT+BT±ADT 与 UIR-PCa 的总生存（OS）改善相关，优于 BT±ADT。
在国家癌症数据库（NCDB）中鉴定了 2004 年至 2015 年间诊断为 UIR-PCa 的男性。采用治疗倾向逆概率加权（IPTW）平衡影响治疗分配和结局的协变量，并采用 Cox 回归模型进行倾向性加权多变量分析（MVA），比较 OS 风险比。
共有 11721 名男性分为四组治疗：（1）BT 无 ADT（n=4535），（2）BT+ADT（n=1303），（3）EBRT+BT（n=3446），或（4）EBRT+BT+ADT（n=2437）。与单独接受 BT 治疗的患者相比，BT+ADT（HR：0.86[95%置信区间（CI）：0.76-0.99]，p=0.03）、EBRT+BT（HR：0.79[0.70-0.88]，p=0.00002）和 EBRT+BT+ADT（HR：0.76[0.67-0.85]，p=0.000003）与 OS 改善相关。在调整权重的 MVA 中，EBRT+BT 与 OS 改善相关（HR：0.82[0.75-0.89]，p=0.000005）。BT 与 EBRT+BT 的 10 年 OS 分别为 62.4%[60.1-64.7]和 69.3%[67.5-71.2]（p<0.0001）。
在 UIR-PCa 男性中，EBRT+BT 与单独 BT 相比与 OS 改善相关，这重申了当前 NCCN 推荐 EBRT+BT 优于单独 BT 的建议。虽然先前的研究报告称，在最佳植入剂量学中，EBRT 加 BT 没有获益，但这项研究表明，EBRT 使植入质量不同的人群受益。
