Department of Radiology, Japan Self-Defense Forces Central Hospital, 1-2-24, Ikejiri, Setagaya-ku, Tokyo 154-8532, Japan.
Department of Radiation Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo 135-8550, Japan.
Jpn J Clin Oncol. 2023 Jun 1;53(6):514-521. doi: 10.1093/jjco/hyad019.
This study aimed to investigate the effect of androgen deprivation therapy (ADT) on the survival of intermediate-risk prostate cancer (IR-PCA) patients treated with dose-escalated external beam radiation therapy (DE-EBRT), and to determine the group that will benefit from ADT.
We analysed 620 IR-PCA patients treated with DE-EBRT at two institutions. Variables were adjusted using the stabilised inverse probability of treatment weighting method (sIPTW) between radiation therapy (RT) and RT plus ADT groups. Biochemical relapse-free survival (bRFS) rate and overall survival (OS) rate were compared using Kaplan-Meier analysis and log-rank test. Cox proportional hazard analysis (CPH) was conducted to detect unfavorable risk factors.
This study included 405 patients; with 217 and 188 patients in the RT and RT plus ADT groups, respectively. The prescribed radiation dose was 78 Gy in 39 fractions. The median follow-up time was 82.0 months. After sIPTW-adjustment, 214.3 and 189.7 patients were assigned to the RT and RT plus ADT groups, respectively. The 7-year bRFS and OS were 89.3% and 94.6% in RT group and 92.3% and 91.0% in RT plus ADT group, respectively. Before and after sIPTW adjustment, no statistically significant differences were found in these endpoints between treatment groups. Multivariate CPH for bRFS revealed Gleason score (GS) 4 + 3 as an unfavorable risk factor, and ADT improved biochemical control of them.
ADT may not always be effective in all Japanese IR-PCA patients treated with DE-EBRT, but it can improve biochemical control in patients with GS 4 + 3.
本研究旨在探讨去势治疗（ADT）对接受大分割外照射放疗（DE-EBRT）治疗的中危前列腺癌（IR-PCA）患者生存的影响，并确定哪些患者将从 ADT 中获益。
我们分析了在两个机构接受 DE-EBRT 治疗的 620 例 IR-PCA 患者。通过放疗（RT）和 RT 加 ADT 组之间的稳定逆概率治疗加权法（sIPTW）调整变量。使用 Kaplan-Meier 分析和对数秩检验比较生化无复发生存率（bRFS）和总生存率（OS）。采用 Cox 比例风险分析（CPH）检测不良风险因素。
本研究共纳入 405 例患者；其中 RT 组和 RT 加 ADT 组分别为 217 例和 188 例。处方剂量为 78Gy，分 39 次给予。中位随访时间为 82.0 个月。sIPTW 调整后，分别有 214.3 例和 189.7 例患者被分配至 RT 组和 RT 加 ADT 组。RT 组的 7 年 bRFS 和 OS 分别为 89.3%和 94.6%，RT 加 ADT 组分别为 92.3%和 91.0%。在调整前后，两组间这些终点均无统计学差异。bRFS 的多变量 CPH 显示 Gleason 评分（GS）4+3 为不良风险因素，ADT 可改善其生化控制。
ADT 对接受 DE-EBRT 治疗的所有日本 IR-PCA 患者可能并非始终有效，但它可改善 GS 4+3 患者的生化控制。
