Department of Urology, University of Luebeck, Luebeck, Germany; Department of Urology, HELIOS Agnes-Karll Hospital Bad Schwartau, Bad Schwartau, Germany.
Department of Urology, University of Luebeck, Luebeck, Germany.
Urol Oncol. 2023 Nov;41(11):454.e17-454.e24. doi: 10.1016/j.urolonc.2023.08.007. Epub 2023 Sep 14.
To validate the subdivision of intermediate-risk (IR) prostate cancer (PCa) into favorable intermediate-risk (FIR) and unfavorable intermediate-risk (UIR) PCa in a historical patient cohort and to compare 2 different radiotherapy regimens.
Patients with intermediate-risk (IR) PCa, treated either by J-LDR-brachytherapy monotherapy (BT) or by combined-modality radiation therapy (CRT), were retrospectively subclassified into FIR and UIR and reanalyzed with regard to biochemical recurrence-free survival (BRFS), metastasis-free survival (MFS), and prostate cancer-specific survival (CSS). Kaplan-Meier product-limit method and log-rank tests were applied to estimate survival probabilities and compare survival, respectively. Uni- and multivariable analyses were performed using Cox proportional hazard regression.
Of 490 IR patients, 252 had received BT (86.5% FIR, 13.5% UIR), and 238 had received CRT (30% FIR, 70% UIR). Retrospective analysis revealed that BRFS at 10 years was 81% for BT, and 94% for CRT in FIR patients. For UIR patients, BRFS at 10 years was 37% for BT, and 89% for CRT. MFS at 10 years for FIR patients was 87% for BT, and 94% for CRT. For UIR patients MFS at 10 years was 78% for BT, and 95% for CRT. In multivariable analysis treatment (BT vs. CRT) was the single associated factor for biochemical recurrence, and for metastases in the UIR group (BFRS, P < 0.001, HR 16.07 (CI 4.23-61.10); MFS, P = 0.011, HR 8.43 (CI 1.62-43.9).
Subclassification of IR prostate cancer into FIR and UIR subcategories appears mandatory. For FIR patients, outcomes after BT monotherapy were acceptable. However, clinical failure after J-LDR-BT in UIR patients was notably increased, suggesting that BT monotherapy was less successful in this risk group. In contrast, the outcome in UIR patients after CRT was excellent.
在历史患者队列中验证中危（IR）前列腺癌（PCa）的细分，即有利中危（FIR）和不利中危（UIR），并比较两种不同的放射治疗方案。
对接受 J-LDR 近距离放射治疗（BT）单药治疗或联合放化疗（CRT）的中危（IR）PCa 患者进行回顾性亚组分析，根据生化无复发生存率（BRFS）、无转移生存率（MFS）和前列腺癌特异性生存率（CSS）重新分析。应用Kaplan-Meier 乘积限法和对数秩检验分别估计生存率和比较生存率。采用单变量和多变量 Cox 比例风险回归分析。
490 例 IR 患者中，252 例接受 BT（86.5% FIR，13.5% UIR），238 例接受 CRT（30% FIR，70% UIR）。回顾性分析显示，FIR 患者 BT 的 10 年 BRFS 为 81%，CRT 为 94%。对于 UIR 患者，BT 的 10 年 BRFS 为 37%，CRT 为 89%。FIR 患者 BT 的 10 年 MFS 为 87%，CRT 为 94%。对于 UIR 患者，BT 的 10 年 MFS 为 78%，CRT 为 95%。多变量分析显示，治疗（BT 与 CRT）是 UIR 组生化复发和转移的单一相关因素（BRFS，P<0.001，HR 16.07（CI 4.23-61.10）；MFS，P=0.011，HR 8.43（CI 1.62-43.9）。
IR 前列腺癌的细分，即 FIR 和 UIR 亚类，似乎是必要的。对于 FIR 患者，BT 单药治疗的结果是可以接受的。然而，J-LDR-BT 后 UIR 患者的临床失败明显增加，表明 BT 单药治疗在该风险组中不太成功。相比之下，UIR 患者 CRT 后的结果是极好的。
