Department of Urology, Peking University Third Hospital, Beijing, China.
Department of Urology, Shandong Cancer Hospital and Institude, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
BMC Surg. 2023 Aug 27;23(1):253. doi: 10.1186/s12893-023-02121-4.
We compared the outcome of radical prostatectomy (RP) with seed brachytherapy (BT) in clinically localized prostate cancer (LPCa) using two different biochemical recurrence (BCR) definitions.
Clinical data of 1117 patients with non-metastatic prostate cancer (PCa) treated with either RP or BT as the basis of the multimodal therapy from a single tertiary hospital between 2007 and 2021 were retrospectively analyzed. 843 LPCa patients (RP = 737, BT = 106) with at least one prostate-specific antigen (PSA) test after treatment were finally included. The BCR survival was evaluated by direct comparison and one-to-one propensity score matching (PSM) analysis using surgical definition (PSA ≥ 0.2ng/ml) for RP and surgical/Phoenix definition (PSA nadir + 2ng/ml ) for BT. The propensity score (PS) was calculated by multivariable logistic regression based on the clinicopathological parameters.
Median follow-up was 43 months for RP patients and 45 months for BT patients. Kaplan-Meier analysis did not show any statistically significant differences in terms of BCR-free survival (BFS) between the two groups when using Phoenix definition for BT (P > 0.05). Similar results were obtained in all D'Amico risk groups when stratified analyses were conducted. However, RP achieved improved BFS compared to BT in the whole cohort and all risk groups with the surgical definition for BT(P < 0.05). After adjusting PS, 192 patients were divided into RP and BT groups (96 each). RP presented a better BFS than BT when using the surgical definition (P < 0.001), but no significant difference was found when using the Phoenix definition (P = 0.609).
Inconsistent BCR-free survival outcomes were acquired using two different BCR definitions for BT patients. RP provided comparable BFS with BT using the Phoenix definition but better BFS using the surgical definition, regardless of whether the PSM was performed. Our findings indicated that an exact BCR definition was critical for prognostic assessment. The corresponding results will assist physicians in pretreatment consultation and treatment selection.
我们比较了根治性前列腺切除术（RP）和种子近距离放射治疗（BT）治疗局限性前列腺癌（LPCa）的结果，使用了两种不同的生化复发（BCR）定义。
回顾性分析了 2007 年至 2021 年期间，一家三级医院采用多模态治疗的非转移性前列腺癌（PCa）患者的临床数据，共 1117 例患者，其中 843 例 LPCa 患者（RP=737，BT=106）在治疗后至少有一次前列腺特异性抗原（PSA）检测。通过直接比较和一对一倾向评分匹配（PSM）分析，使用 RP 的手术定义（PSA≥0.2ng/ml）和 BT 的手术/凤凰定义（PSA 最低点+2ng/ml）评估 BCR 生存情况。基于临床病理参数，使用多变量逻辑回归计算倾向得分（PS）。
RP 患者的中位随访时间为 43 个月，BT 患者的中位随访时间为 45 个月。Kaplan-Meier 分析显示，当使用凤凰定义时，两组之间在 BCR 无复发生存率（BFS）方面没有统计学上的显著差异（P>0.05）。当进行分层分析时，在所有 D'Amico 风险组中都得到了类似的结果。然而，当使用 BT 的手术定义时，RP 在整个队列和所有风险组中均比 BT 获得了更好的 BFS（P<0.05）。在调整 PS 后，将 192 例患者分为 RP 和 BT 组（每组 96 例）。当使用手术定义时，RP 的 BFS 优于 BT（P<0.001），但当使用凤凰定义时，两组之间没有显著差异（P=0.609）。
使用两种不同的 BT 患者 BCR 定义，获得了不一致的 BCR 无复发生存率结果。使用凤凰定义时，RP 与 BT 具有可比的 BFS，但使用手术定义时，RP 具有更好的 BFS，无论是否进行 PSM。我们的研究结果表明，确切的 BCR 定义对预后评估至关重要。相应的结果将有助于医生在治疗前咨询和治疗选择。
