Andring Lauren M, Abu-Gheida Ibrahim, Bathala Tharakeswara, Yoder Alison K, Manzar Gohar S, Maldonado J Alberto, Frank Steven J, Choi Seungtaek, Nguyen Quynh-Nhu, Hoffman Karen, McGuire Sean Eric, Mok Henry, Aparicio Ana, Chapin Brian F, Tang Chad
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Radiation Oncology, Burjeel Medical City, Abu Dhabi, United Arab Emirates.
BJU Int. 2023 Sep;132(3):307-313. doi: 10.1111/bju.16027. Epub 2023 Apr 25.
To evaluate patients with clinical (c)T4 prostate cancer (PCa), which represent both a heterogenous and understudied population, who often present with locally advanced disease and obstructive symptoms causing significant morbidity and mortality. We analysed whether receiving definitive local therapy influenced symptomatic and oncological outcomes.
Retrospective analysis of 154 patients with cT4 PCa treated at a single institution in 1996-2020. Systemic therapy with or without local treatment (surgery, radiotherapy [RT], or both). Uni- and multivariate analyses of associations between clinicopathological features (including obstructive symptoms) and receipt of local therapy on overall survival (OS) and disease control were done with Cox regression.
The median follow-up time was 5.9 years. Most patients had adenocarcinoma (88%), Gleason score 9-10 (77%), and median baseline prostate-specific antigen (PSA) of 20 ng/mL; most (54%) had metastatic cT4N0-1M1 disease; 24% regionally advanced cT4N1M0, and 22% localised cT4N0M0. Local therapies were RT (n = 44), surgery (n = 28), or both (n = nine). Local therapy was associated with improved OS (hazard ratio [HR] 0.3, P < 0.001), longer freedom from local recurrence (HR 0.39, P = 0.002), less local progression (HR 0.41, P = 0.02), fewer obstructive symptoms with progression (HR 0.31, P = 0.01), and less death from local disease (HR 0.25, P = 0.002). On multivariate, local therapy was associated with improved survival (HR 0.58, P = 0.02), and metastatic disease (HR 2.93, P < 0.001) or high-risk pathology (HR 2.05, P = 0.03) was associated with worse survival.
Definitive local therapy for cT4 PCa was associated with improved symptomatic outcomes and survival even among men with metastatic disease. Pending prospective evaluation, these findings support definitive treatment with local therapy for cT4 disease in select cases.
评估临床（c）T4期前列腺癌（PCa）患者，这是一类异质性且研究不足的人群，他们常表现为局部晚期疾病和阻塞性症状，导致显著的发病率和死亡率。我们分析了接受确定性局部治疗是否会影响症状和肿瘤学结局。
对1996年至2020年在单一机构接受治疗的154例cT4期PCa患者进行回顾性分析。采用全身治疗联合或不联合局部治疗（手术、放疗[RT]或两者皆用）。使用Cox回归对临床病理特征（包括阻塞性症状）与局部治疗的接受情况之间的关联进行单因素和多因素分析，以评估总生存期（OS）和疾病控制情况。
中位随访时间为5.9年。大多数患者为腺癌（88%），Gleason评分9 - 10分（77%），基线前列腺特异性抗原（PSA）中位数为20 ng/mL；大多数（54%）有转移性cT4N0 - 1M1疾病；24%为区域晚期cT4N1M0，22%为局限性cT4N0M0。局部治疗包括放疗（n = 44）、手术（n = 28）或两者皆用（n = 9）。局部治疗与改善的OS相关（风险比[HR] 0.3，P < 0.001），更长的无局部复发时间（HR 0.39，P = 0.002），更少的局部进展（HR 0.41，P = 0.02），进展时更少的阻塞性症状（HR 0.31，P = 0.01），以及更少的局部疾病死亡（HR 0.25，P = 0.002）。在多因素分析中，局部治疗与生存改善相关（HR 0.58，P = 0.02），而转移性疾病（HR 2.93，P < 0.001）或高危病理（HR 2.05，P = 0.03）与较差的生存相关。
即使在患有转移性疾病的男性中，cT4期PCa的确定性局部治疗也与改善的症状结局和生存相关。在进行前瞻性评估之前，这些发现支持在某些情况下对cT4期疾病采用局部治疗进行确定性治疗。
