Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA.
Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, USA.
Cancer Med. 2022 Aug;11(15):2886-2895. doi: 10.1002/cam4.4656. Epub 2022 Mar 15.
The optimal upfront treatment modality for patients with nonmetastatic Gleason Score 9 and 10 prostate cancer (GS 9-10 PCa) is unknown.
We conducted a retrospective cohort study of patients in the Veterans Health Administration (VHA) with GS 9-10 PCa treated with radical prostatectomy (RP) or external beam radiation therapy with androgen deprivation therapy (EBRT+ADT) from 1/2000 to 12/2010. Outcomes included overall survival (OS), distant metastasis-free survival (DMFS), and salvage/adjuvant therapy-free survival (SAFS), as assessed by Kaplan-Meier analysis.
We identified 1220 veterans with GS 9-10 PCa; 335 were treated with RP, and 885 were treated with EBRT+ADT. With a median follow-up of 9.9 years, propensity score-matched analyses demonstrated that RP had superior 10-year OS (70.8% [RP] vs. 61.2% [EBRT+ADT], p < 0.001), 10-year DMFS rates were similar between RP (76.7%) and EBRT+ADT (81.0%), and 10-year SAFS rates were lower for RP vs EBRT + ADT (35.2% [RP] vs. 75.2% [EBRT+ADT], p < 0.001). The receipt of salvage ADT was higher with upfront RP (51.9% vs. 26.1%, p < 0.001), despite receipt of adjuvant/salvage EBRT in 41.8% of RP patients. Among patients treated with RP, there were no differences in outcomes by race. However, higher survival rates were noted among Black patients treated with EBRT+ADT compared with White patients.
This analysis demonstrated higher 10-year OS rates among men treated with upfront RP versus EBRT+ADT, though missing confounders and similar DMFS rates suggest the long-term cause-specific OS rates may be similar. We also highlight real-world outcomes of a diverse patient population in the VHA and improved outcomes for Black patients receiving EBRT+ADT.
对于非转移性 Gleason 评分 9 和 10 前列腺癌（GS 9-10 PCa）患者，最佳的初始治疗方式尚不清楚。
我们对退伍军人事务部（VHA）中接受根治性前列腺切除术（RP）或外照射放疗联合雄激素剥夺治疗（EBRT+ADT）治疗的 GS 9-10 PCa 患者进行了回顾性队列研究。通过 Kaplan-Meier 分析评估总生存（OS）、远处无转移生存（DMFS）和挽救/辅助治疗无生存（SAFS）等结局。
我们确定了 1220 名 GS 9-10 PCa 退伍军人；其中 335 名接受 RP 治疗，885 名接受 EBRT+ADT 治疗。中位随访时间为 9.9 年，倾向评分匹配分析表明 RP 治疗的 10 年 OS 更高（70.8% [RP] 与 61.2% [EBRT+ADT]，p<0.001），RP 与 EBRT+ADT 治疗的 10 年 DMFS 率相似（76.7%与 81.0%），而 RP 治疗的 10 年 SAFS 率低于 EBRT+ADT（35.2% [RP] 与 75.2% [EBRT+ADT]，p<0.001）。尽管 41.8%的 RP 患者接受了辅助/挽救性 EBRT，但 RP 患者中接受挽救性 ADT 的比例更高（51.9%与 26.1%，p<0.001）。在接受 RP 治疗的患者中，种族之间的结局没有差异。然而，接受 EBRT+ADT 治疗的黑人患者的生存率高于白人患者。
与 EBRT+ADT 相比，初始接受 RP 治疗的男性 10 年 OS 率更高，但缺失混杂因素且 DMFS 率相似，提示长期特定原因 OS 率可能相似。我们还强调了 VHA 中多样化患者人群的真实世界结局，以及接受 EBRT+ADT 治疗的黑人患者的结局改善。
