临床淋巴结阳性前列腺癌根治性前列腺切除术与放疗的生存比较。
Survival after radical prostatectomy versus radiation therapy in clinical node-positive prostate cancer.
机构信息
Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.
Department of Urology, Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal , Québec, Canada.
出版信息
Prostate. 2022 May;82(6):740-750. doi: 10.1002/pros.24317. Epub 2022 Feb 28.
AIM
To compare overall mortality (OM), cancer-specific mortality (CSM), and other cause mortality (OCM) rates between radical prostatectomy (RP) versus radiotherapy (RT) in clinical node-positive (cN1) prostate cancer (PCa).
MATERIALS AND METHODS
Within Surveillance, Epidemiology, End Results (SEER) (2004-2016), we identified 4685 cN1 PCa patients, of whom 3589 (76.6%) versus 1096 (24.4%) were treated with RP versus RT. After 1:1 propensity score matching (PSM), Kaplan-Meier plots and Cox regression models tested the effect of RP versus RT on OM, while cumulative incidence plots and competing-risks regression (CRR) models addressed CSM and OCM between RP and RT patients. All analyses were repeated after the inverse probability of treatment weighting (IPTW). For CSM and OCM analyses, the propensity score was used as a covariate in the regression model.
RESULTS
Overall, RT patients were older, harbored higher prostate-specific antigen values, higher clinical T and higher Gleason grade groups. PSM resulted in two equally sized groups of 894 RP versus 894 RT patients. After PSM, 5-year OM, CSM, and OCM rates were, respectively, 15.4% versus 25%, 9.3% versus 17%, and 6.1% versus 8% for RP versus RT (all p < 0.001) and yielded respective multivariate hazard ratios (HRs) of 0.63 (0.52-0.78, p < 0.001), 0.66 (0.52-0.86, p < 0.001), 0.71 (0.5-1.0, p = 0.05), all favoring RP. After IPTW, Cox regression models yielded HR of 0.55 (95% confidence interval [CI] = 0.46-0.66) for OM, and CRR yielded HRs of 0.49 (0.34-0.70) and 0.54 (0.36-0.79) for, respectively, CSM and OCM, all favoring RP (all p < 0.001).
CONCLUSIONS
RP may hold a CSM advantage over RT in cN1 PCa patients.
目的
比较临床淋巴结阳性（cN1）前列腺癌（PCa）患者中根治性前列腺切除术（RP）与放疗（RT）的总死亡率（OM）、癌症特异性死亡率（CSM）和其他原因死亡率（OCM）。
材料与方法
我们在监测、流行病学和最终结果（SEER）数据库（2004-2016 年）中，共确定了 4685 例 cN1 PCa 患者，其中 3589 例（76.6%）接受了 RP 治疗，1096 例（24.4%）接受了 RT 治疗。1:1 倾向评分匹配（PSM）后，Kaplan-Meier 图和 Cox 回归模型检测 RP 与 RT 对 OM 的影响，累积发病率图和竞争风险回归（CRR）模型分析 RP 与 RT 患者的 CSM 和 OCM。所有分析均在逆概率治疗加权（IPTW）后重复。对于 CSM 和 OCM 分析，将倾向评分作为回归模型中的协变量。
结果
总体而言，RT 患者年龄较大，前列腺特异性抗原值较高，临床 T 分期和 Gleason 分级较高。PSM 后，RP 与 RT 患者各有 894 例，两组患者数量相等。PSM 后，RP 与 RT 患者的 5 年 OM、CSM 和 OCM 发生率分别为 15.4%比 25%、9.3%比 17%、6.1%比 8%（均 p<0.001），多变量风险比（HR）分别为 0.63（0.52-0.78，p<0.001）、0.66（0.52-0.86，p<0.001）、0.71（0.5-1.0，p=0.05），均有利于 RP。经 IPTW 后，Cox 回归模型的 OM 风险比为 0.55（95%置信区间[CI]：0.46-0.66），CRR 的 CSM 和 OCM 风险比分别为 0.49（0.34-0.70）和 0.54（0.36-0.79），均有利于 RP（均 p<0.001）。
结论
在 cN1 PCa 患者中，RP 可能较 RT 具有 CSM 优势。
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