Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA.
Division of Urology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
Cancer Med. 2024 Aug;13(15):e70060. doi: 10.1002/cam4.70060.
The optimal treatment approach for low-risk prostate cancer (LRPC) remains controversial. While active surveillance is an increasingly popular option, definitive local treatments, including radical prostatectomy (RP), external beam radiotherapy (EBRT), and prostate seed implantation (PSI), are also commonly used. This study aimed to evaluate the survival outcomes of patients with LRPC using a large patient population from the National Cancer Database (NCDB).
We analyzed data from 195,452 patients diagnosed with LRPC between 2004 and 2015 using the NCDB. Patients were classified based on their treatment modalities, including RP, EBRT, PSI, or no local treatment (NLT). Only patients with Charlson-Deyo comorbidity scores of 0 or 1 were included to ensure comparability. Propensity score analysis was used to balance the treatment groups, and the accelerated failure time model was used to analyze the survival rates of the treatment groups.
After a median follow-up of 70.8 months, 24,545 deaths occurred, resulting in an all-cause mortality rate of 13%. RP demonstrated a survival benefit compared with NLT, particularly in patients younger than 74 years of age. In contrast, radiation treatments (EBRT and PSI) did not improve survival in the younger age groups, except for patients older than 70 years for EBRT and older than 65 years for PSI. Notably, EBRT in patients younger than 65 years was associated with inferior outcomes.
This study highlights the differences in survival outcomes among LRPC treatment modalities. RP was associated with improved survival compared to NLT, especially in younger patients. In contrast, EBRT and PSI showed survival benefits primarily in the older age groups. NLT is a reasonable choice, particularly in younger patients when RP is not chosen. These findings emphasize the importance of individualized treatment decisions for LRPC management.
低危前列腺癌（LRPC）的最佳治疗方法仍存在争议。虽然主动监测是一种越来越受欢迎的选择，但根治性前列腺切除术（RP）、外束放射治疗（EBRT）和前列腺种子植入（PSI）等确定性局部治疗方法也常被使用。本研究旨在利用国家癌症数据库（NCDB）中的大量患者人群评估 LRPC 患者的生存结果。
我们分析了 2004 年至 2015 年间 NCDB 中诊断为 LRPC 的 195452 例患者的数据。根据治疗方式对患者进行分类，包括 RP、EBRT、PSI 或无局部治疗（NLT）。仅纳入 Charlson-Deyo 合并症评分为 0 或 1 的患者，以确保可比性。采用倾向评分分析平衡治疗组，并采用加速失效时间模型分析治疗组的生存率。
中位随访 70.8 个月后，共有 24545 例患者死亡，总死亡率为 13%。与 NLT 相比，RP 显示出生存优势，特别是在 74 岁以下的患者中。相比之下，年轻患者中，EBRT 和 PSI 等放疗并未改善生存，除了 70 岁以上的 EBRT 和 65 岁以上的 PSI 患者。值得注意的是，65 岁以下患者接受 EBRT 后预后较差。
本研究强调了 LRPC 治疗方式之间生存结果的差异。与 NLT 相比，RP 与改善生存相关，尤其是在年轻患者中。相比之下，EBRT 和 PSI 主要在老年患者中显示出生存获益。NLT 是一种合理的选择，尤其是在年轻患者不选择 RP 时。这些发现强调了为 LRPC 管理做出个体化治疗决策的重要性。
