近距离放疗与根治性前列腺切除术治疗局限性前列腺癌的疗效比较——倾向评分匹配分析。

Efficacy of brachytherapy versus radical prostatectomy for localized prostate cancer-propensity score-matched comparison.

机构信息

Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, 365 East Renming Road, Jinhua, Zhejiang, 321000, China.

Department of Endocrinology, Affiliated Second Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.

出版信息

BMC Cancer. 2024 Sep 27;24(1):1177. doi: 10.1186/s12885-024-12933-z.

DOI:10.1186/s12885-024-12933-z

PMID:39334019

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11438048/

Abstract

OBJECTIVE

The brachytherapy (BT) and radical prostatectomy (RP) are two methods recommended in current guidelines for the treatment of localized prostate cancer (PCa). It is difficult to compare the oncological results of these two treatments because of differences in baseline characteristics and treatment selection.we sought to compare the efficacy of BT and RP after propensity score matching(PSM)analysis.

METHODS

Between January 2009 and December 2021, our institution treated 657 patients with localized PCa (BT: n = 198; RP: n = 459)and followed up for > 2 years. Biochemical recurrence was defined as prostate-specific antigen (PSA) levels of nadir plus 2 ng/ml or higher (Phoenix definition) for BT, and as PSA0.2 ng/ml or greater for RP. PSM was applied based on the age, body mass index, PSA, prostate volume, clinical T-stage, Gleason grade, percentage of positive puncture needles ≥ 1/2, maximum tumor diameter ≥ 5 mm, and follow-up period.

RESULTS

Median follow-up was 63 months for BT and 52 months for RP. After propensity score adjustment, a total of 294 (147 each) patients remained for further analysis.Kaplan-Meier curves showed no statistically significant difference in clinical relapse-free survivals (cRFS) (p = 0.637),overall survival (OS) (p = 0.726),and cancer-specific survival (CSS) (p = 0.505).BT was associated with improved biochemical relapse-free survivals (bRFS) compared to RP (p = 0.022), Logistic multivariate analysis based on the whole cohort revealed that clinical T stage ≥ T (p = 0.043) and tumor maximum diameter ≥ 5 mm (p = 0.044) were associated with significantly bRFS.

CONCLUSION

The BT and RP group patients exhibited similar cRFS, OS, and CSS. However, patients in the BT groups exhibited better bRFS than those in the RP group.Clinical T stage ≥ T and a maximum tumor diameter ≥ 5 mm were independent prognostic factors.

摘要

目的

在当前的前列腺癌（PCa）治疗指南中，推荐采用近距离放射治疗（BT）和根治性前列腺切除术（RP）这两种方法。由于基线特征和治疗选择的差异，比较这两种治疗方法的肿瘤学结果较为困难。本研究旨在通过倾向评分匹配（PSM）分析比较 BT 和 RP 的疗效。

方法

2009 年 1 月至 2021 年 12 月，本机构共收治 657 例局限性 PCa 患者（BT：n=198；RP：n=459），并进行了随访，随访时间超过 2 年。BT 患者的生化复发定义为前列腺特异性抗原（PSA）水平达到最低点加 2ng/ml 或更高（Phoenix 定义），RP 患者的生化复发定义为 PSA0.2ng/ml 或更高。基于年龄、体重指数、PSA、前列腺体积、临床 T 分期、Gleason 分级、阳性穿刺针数比例≥1/2、最大肿瘤直径≥5mm 和随访时间，进行 PSM。

结果

BT 和 RP 的中位随访时间分别为 63 个月和 52 个月。在进行倾向评分调整后，共有 294 例（每组 147 例）患者纳入进一步分析。Kaplan-Meier 曲线显示，临床无复发生存率（cRFS）（p=0.637）、总生存率（OS）（p=0.726）和癌症特异性生存率（CSS）（p=0.505）无统计学差异。与 RP 相比，BT 与生化无复发生存率（bRFS）的改善相关（p=0.022）。基于全队列的 logistic 多因素分析显示，临床 T 分期≥T（p=0.043）和肿瘤最大直径≥5mm（p=0.044）与 bRFS 显著相关。