桓兴医讯

北京桓兴医院,桓兴医院,桓兴肿瘤医院

推荐文章

您当前位置:桓兴肿瘤医院 > 桓兴医讯 > 桓兴医讯 以近距离放射治疗为基础的放射治疗与根治性前列腺切除
桓兴医讯 以近距离放射治疗为基础的放射治疗与根治性前列腺切除
文章来源:北京市朝阳区桓兴肿瘤医院 点击数: 发布时间:2018-03-05 13:55
美国《临床肿瘤学杂志》2017年2月28日在线先发
以近距离放射治疗为基础的放射治疗与根治性前列腺切除术治疗高危局限性前列腺癌生存率相近
目的
对于高危局限性前列腺癌患者,在选择放疗和手术之间,尚无指导治疗决策的随机临床试验。由于难以基于治疗前的预后因素对患者进行匹配分组,且难以就放疗患者和手术患者之间的癌症相关性差异、医疗差异和社会经济差异这些因素进行校正,因此难以进行比较性研究。
方法
在(美国)国家癌症数据库中,我们分析了所有临床局限性的高危前列腺癌患者的转归,这些患者有完整的预后数据、接受了根治性前列腺切除术(RP)、联合去势治疗(AD)的外照射放射治疗(EBRT)、或者联合/不联合去势治疗(AD)的外照射放射治疗(EBRT)+近距离放疗。采用治疗加权逆概率,对治疗组间不均衡的协变量进行校正,然后采用加权时变性Cox比例风险模型,评估治疗组对患者生存的影响,从而分析起初实施差异化治疗的原因。采用前列腺特异性抗原水平、格里森评分分值和临床T分期,构建淋巴结病理(pLN)状态的预测模型,并采用预测的淋巴结病理(pLN)状态,来重复治疗加权逆概率和时变性Cox比例风险模型。
结果
共计分析了42765名患者。在根治性前列腺切除术(RP)组与联合/不联合去势治疗(AD)的外照射放射治疗(EBRT)+近距离放疗组之间,生存上没有统计学的显著差异(风险比[HR],1.17;95%CI,0.88-1.55)。但外照射放射治疗(EBRT)+去势治疗(AD)组的死亡率高于根治性前列腺切除术(RP)组(HR,1.53;95%CI,1.22-1.92),对预测的淋巴结病理(pLN)状态进行校正,统计学上的结果一致。一项敏感性分析表明,≥7920cGy的外照射放射治疗(EBRT)+去势治疗(AD)使差异缩小,但死亡率仍然明显高(HR,1.33;95%CI,1.05-1.68)。 结论 这项分析显示,对组间不均衡的前列腺癌预后因素、其他医疗条件和社会经济因素进行全面校正后,在根治性前列腺切除术(RP)患者对比联合/不联合去势治疗(AD)的外照射放射治疗(EBRT)+近距离放疗患者之间,生存上没有统计学上的差异,外照射放射治疗(EBRT)+去势治疗(AD)与较低的生存率相关。
北京市朝阳区桓兴肿瘤医院 桓兴医讯编译组 孙莉
2018年3月5日 星期一
Brachytherapy-Based Radiotherapy and Radical Prostatectomy Are Associated With Similar Survival in High-Risk Localized Prostate Cancer
Purpose
There are no randomized trials to guide treatment decisions between radiotherapeutic and surgical options for patients with high-risk localized prostate cancer. Comparative studies have been limited by their ability to match patients on the basis of pretreatment prognostic variables and to adjust for the cancer-related, medical, and socioeconomic differences between patients who choose radiotherapeutic or surgical approaches.
Methods
We analyzed the outcome of all patients in the National Cancer Database with high-risk, clinically localized prostate cancer with complete prognostic data who were treated with either radical prostatectomy (RP), external beam radiotherapy (EBRT) combined with androgen deprivation (AD), or EBRT plus brachytherapy with or without AD. Inverse probability of treatment weighting was used to adjust for covariable imbalance among treatment groups. The weighted time-dependent Cox proportional hazards model was then used to estimate the effects of treatment groups on survival, accounting for differential treatment initiation times. A predictive model of pathologic nodal (pLN) status was built using prostate-specific antigen level, Gleason score, and clinical T stage; predicted pLN status was used to repeat the inverse probability of treatment weighting and time-dependent Cox proportional hazards model.
Results
A total of 42,765 patients were analyzed. There was no statistically significant difference in survival between RP and EBRT plus brachytherapy with or without AD (hazard ratio [HR], 1.17; 95% CI, 0.88 to 1.55). However, EBRT plus AD was associated with higher mortality than RP (HR, 1.53; 95% CI, 1.22 to 1.92). Adjustment for predicted pLN status did not yield statistically different results. A sensitivity analysis showed that EBRT plus AD ≥ 7920 cGy narrowed the difference, but a significantly higher mortality remained (HR, 1.33; 95% CI, 1.05 to 1.68).
Conclusion
After comprehensively adjusting for imbalances in prostate cancer prognostic factors, other medical conditions, and socioeconomic factors, this analysis showed no statistical difference in survival between patients treated with RP versus EBRT plus brachytherapy with or without AD. EBRT plus AD was associated with lower survival.

标签:

北京桓兴肿瘤医院,北京朝阳区桓兴肿瘤医院,桓兴肿瘤医院,北京桓兴医院,北京专科肿瘤医院 北京桓兴肿瘤医院,北京朝阳区桓兴肿瘤医院,桓兴肿瘤医院,北京桓兴医院,北京专科肿瘤医院