The Christie NHS Foundation Trust, Manchester, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
The Christie NHS Foundation Trust, Manchester, UK.
Radiother Oncol. 2023 Sep;186:109746. doi: 10.1016/j.radonc.2023.109746. Epub 2023 Jun 16.
To evaluate clinical outcomes for cN1M0 prostate cancer treated with varied modalities.
Men with radiological stage cN1M0 prostate cancer on conventional imaging, treated from 2011-2019 with various modalities across four centres in the UK were included. Demographics, tumour grade and stage, and treatment details were collected. Biochemical and radiological progression-free survival (bPFS, rPFS) and overall survival (OS) were estimated using Kaplan Meier analyses. Potential factors impacting survival were tested with univariable log-rank test and multivariable Cox-proportional hazards model.
Total 337 men with cN1M0 prostate cancer were included, 47% having Gleason grade group 5 disease. Treatment modalities included androgen deprivation therapy (ADT) in 98.9% men, either alone (19%) or in combinations including prostate radiotherapy (70%), pelvic nodal radiotherapy (38%), docetaxel (22%), or surgery (7%). At median follow up of 50 months, 5-year bPFS, rPFS, and OS were 62.7%, 71.0%, and 75.8% respectively. Prostate radiotherapy was associated with significantly higher bPFS (74.1% vs 34.2%), rPFS (80.7% vs 44.3%) and OS (86.7% vs 56.2%) at five years (log rank p < 0.001 each). On multivariable analysis including age, Gleason grade group, tumour stage, ADT duration, docetaxel, and nodal radiotherapy, benefit of prostate radiotherapy persisted for bPFS [HR 0.33 (95% CI 0.18-0.62)], rPFS [HR 0.25 (0.12-0.51)], and OS [HR 0.27 (0.13-0.58)] (p < 0.001 each). Impact of nodal radiotherapy or docetaxel was not established due to small subgroups.
Addition of prostate radiotherapy to ADT in cN1M0 prostate cancer yielded improved disease control and overall survival independent of other tumour and treatment factors.
评估采用不同方法治疗 cN1M0 前列腺癌的临床结果。
纳入了 2011 年至 2019 年间在英国四个中心采用不同方法治疗的常规影像学上有 cN1M0 前列腺癌的男性患者。收集了患者的人口统计学、肿瘤分级和分期以及治疗细节等信息。使用 Kaplan-Meier 分析估计生化无进展生存期（bPFS、rPFS）和总生存期（OS）。使用单变量对数秩检验和多变量 Cox 比例风险模型检验影响生存的潜在因素。
共纳入 337 例 cN1M0 前列腺癌患者，其中 47%患者的 Gleason 分级组为 5 级。治疗方法包括雄激素剥夺治疗（ADT），98.9%的患者接受 ADT 治疗，其中 19%的患者单独接受 ADT 治疗，70%的患者接受 ADT 联合前列腺放疗、38%的患者接受盆腔淋巴结放疗、22%的患者接受多西他赛治疗、7%的患者接受手术治疗。中位随访 50 个月后，5 年 bPFS、rPFS 和 OS 分别为 62.7%、71.0%和 75.8%。前列腺放疗在 5 年时与更高的 bPFS（74.1%比 34.2%）、rPFS（80.7%比 44.3%）和 OS（86.7%比 56.2%）显著相关（log-rank p 值均<0.001）。在包括年龄、Gleason 分级组、肿瘤分期、ADT 持续时间、多西他赛和淋巴结放疗在内的多变量分析中，前列腺放疗对 bPFS[HR 0.33（95%CI 0.18-0.62）]、rPFS[HR 0.25（0.12-0.51）]和 OS[HR 0.27（0.13-0.58）]的获益仍然存在（p 值均<0.001）。由于亚组人数较少，无法确定淋巴结放疗或多西他赛的影响。
在 cN1M0 前列腺癌患者中，在 ADT 治疗的基础上联合前列腺放疗可提高疾病控制率和总体生存率，且不受其他肿瘤和治疗因素的影响。
