近距离放疗联合外照射放疗可改善中高危前列腺癌患者的生存情况，并降低远处转移风险，优于单纯外照射放疗。
Brachytherapy boost improves survival and decreases risk of developing distant metastases compared to external beam radiotherapy alone in intermediate and high risk group prostate cancer patients.
机构信息
IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland.
出版信息
Radiother Oncol. 2023 Jun;183:109632. doi: 10.1016/j.radonc.2023.109632. Epub 2023 Mar 23.
BACKGROUND AND PURPOSE
Despite several prospective trials showing a clinical benefit of combining external beam radiotherapy (EBRT) with brachytherapy boost (BTB) for the treatment of intermediate- and high-risk prostate cancer (PCa) patients, none of these trials was designed to test for a survival difference. In this study, we aimed to collect a large multi-institutional database to determine whether BT boost was associated with a statistically significant improvement in survival and a reduction of distant metastases based on real-world data.
MATERIAL AND METHODS
We collected the data of patients treated for intermediate- or high-risk PCa with definitive EBRT or BTB, with or without androgen deprivation therapy (ADT), between January 2003 and December 2014 at two tertiary institutions. The statistical endpoints included overall survival (OS), freedom from distant metastases (FFDM), and metastases-free survival (MFS). The impact of treatment modality was assessed using Cox regression models and log-rank testing after one-to-one propensity score matching.
RESULTS
A total of 1641 patients treated with EBRT (n = 1148) or high-dose-rate BTB (n = 493) were analyzed. The median survival and clinical follow-up were 117.8 (IQR 78-143.3) and 60.7 months, respectively. The radiotherapy modality (BTB) remained an independent prognostic factor for OS (HR 0.75; 95% CI 0.63-0.88; p < 0.001), FFDM (HR 0.54; 95% CI 0.4-0.73; p < 0.001), and MFS (HR 0.72; 95% CI 0.61-0.85; p < 0.001). After propensity score matching, the remaining 986 patients were well-balanced in terms of age, maximum PSA, ISUP grade group, and TNM T stage. OS (p < 0.001), FFDM (p = 0.001) and MFS (p < 0.001) were significantly higher in the BTB group.
CONCLUSIONS
There is a strong positive association between BTB and OS, FFDM, and MFS in PCa patients treated with definitive RT for intermediate- or high-risk PCa.
背景与目的
尽管多项前瞻性试验显示，对于中高危前列腺癌（PCa）患者，联合外照射放疗（EBRT）与近距离放疗（BTB）加量治疗具有临床获益，但这些试验均未设计用于检验生存差异。本研究旨在收集大型多机构数据库，以确定基于真实世界数据，BTB 是否与生存的统计学显著改善和远处转移减少相关。
材料与方法
我们收集了 2003 年 1 月至 2014 年 12 月在两家三级机构接受根治性 EBRT 或 BTB 治疗（伴或不伴雄激素剥夺治疗（ADT））的中高危 PCa 患者的数据。主要终点包括总生存（OS）、无远处转移生存（FFDM）和无转移生存（MFS）。使用 Cox 回归模型和对数秩检验在一对一倾向评分匹配后评估治疗方式的影响。
结果
共分析了 1641 例接受 EBRT（n=1148）或高剂量率 BTB（n=493）治疗的患者。中位生存时间和临床随访时间分别为 117.8（IQR 78-143.3）和 60.7 个月。放疗方式（BTB）仍然是 OS（HR 0.75；95%CI 0.63-0.88；p<0.001）、FFDM（HR 0.54；95%CI 0.4-0.73；p<0.001）和 MFS（HR 0.72；95%CI 0.61-0.85；p<0.001）的独立预后因素。在倾向评分匹配后，986 例患者在年龄、最大 PSA、ISUP 分级组和 TNM T 分期方面具有良好的平衡。BTB 组的 OS（p<0.001）、FFDM（p=0.001）和 MFS（p<0.001）均显著更高。
结论
在接受根治性 RT 治疗的中高危 PCa 患者中，BTB 与 OS、FFDM 和 MFS 之间存在强烈的正相关关系。
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