局部前列腺放疗与初发转移性前列腺癌的局部症状事件。
Local Prostate Radiation Therapy and Symptomatic Local Events in De Novo Metastatic Prostate Cancer.
机构信息
Tom Baker Cancer Centre, Calgary, Alberta, Canada; Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
Division of Urology, Department of Surgery, University of Calgary and Southern Alberta Institute of Urology, Calgary, Alberta, Canada.
出版信息
Pract Radiat Oncol. 2023 Jan-Feb;13(1):e61-e67. doi: 10.1016/j.prro.2022.08.005. Epub 2022 Sep 5.
PURPOSE
Local prostate radiation therapy (LPRT) for low-burden metastatic prostate cancer (mPCa) improves overall survival and is the standard of care. The role of LPRT in reducing symptomatic local events (SLE) remains unclear. We aimed to identify SLE risk factors and to evaluate the association between LPRT and SLE in mPCa.
METHODS AND MATERIALS
We conducted a retrospective, population-based cohort study of patients initially diagnosed with mPCa between 2005 and 2016 in a cancer registry. Patient, tumor, and treatment characteristics were obtained from chart review and the cancer registry. The coprimary endpoints were genitourinary (GU) and gastrointestinal (GI) SLE, identified by physician billing claims between 2004 and 2017 for diagnostic or therapeutic procedures potentially related to GU and GI SLE. The effect of LPRT on SLE was evaluated using both recurrent event (Andersen-Gill model) and time-to-first-event sequential landmark analyses. Risk factors for SLE were assessed by multivariable Cox regression. LPRT was defined as ≥40 Gy within 1 year of diagnosis. Metastatic burden was defined per the STAMPEDE trial.
RESULTS
Of 1363 patients, 46 (3.4%) received LPRT. Median follow-up was 27.3 and 28.9 months in the control and LPRT groups, respectively. LPRT was associated with less recurrent GU SLE (hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.17-0.67; P = .002), upper tract obstruction (HR, 0.20; 95% CI, 0.05-0.84; P = .03), and cystoscopy (HR, 0.38; 95% CI, 0.15-0.96; P = .04). Metastatic burden was not associated with SLE.
CONCLUSIONS
LPRT in mPCa was associated with less recurrent GU SLE, specifically for upper tract obstruction and cystoscopy.
目的
局部前列腺放射治疗（LPRT）治疗低负担转移性前列腺癌（mPCa）可提高总生存率，是标准治疗方法。LPRT 降低症状性局部事件（SLE）的作用仍不清楚。我们旨在确定 SLE 的危险因素，并评估 mPCa 中 LPRT 与 SLE 之间的关系。
方法和材料
我们对 2005 年至 2016 年间癌症登记处诊断为 mPCa 的患者进行了回顾性、基于人群的队列研究。通过病历回顾和癌症登记处获得患者、肿瘤和治疗特征。主要终点是泌尿生殖系统（GU）和胃肠道（GI）SLE，通过 2004 年至 2017 年期间与 GU 和 GI SLE 相关的诊断或治疗程序的医生计费索赔来确定。通过复发事件（Andersen-Gill 模型）和首次事件序贯 landmark 分析评估 LPRT 对 SLE 的影响。通过多变量 Cox 回归评估 SLE 的危险因素。LPRT 定义为诊断后 1 年内接受≥40Gy 的治疗。转移性负担根据 STAMPEDE 试验定义。
结果
在 1363 名患者中，有 46 名（3.4%）接受了 LPRT。对照组和 LPRT 组的中位随访时间分别为 27.3 和 28.9 个月。LPRT 与 GU 复发 SLE 减少相关（风险比 [HR]，0.34；95%置信区间 [CI]，0.17-0.67；P=0.002）、上尿路梗阻（HR，0.20；95%CI，0.05-0.84；P=0.03）和膀胱镜检查（HR，0.38；95%CI，0.15-0.96；P=0.04）。转移性负担与 SLE 无关。
结论
mPCa 中的 LPRT 与 GU 复发 SLE 减少相关，特别是上尿路梗阻和膀胱镜检查。
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