Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer.
Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer.
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DOI：
10.1002/cncr.25456
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发表时间：
2010-11-15
期刊：
影响因子：
6.2
通讯作者：
Carroll, Peter R.
中科院分区：
文献类型：
--
作者：
Cooperberg, Matthew R.;Vickers, Andrew J.;Broering, Jeanette M.;Carroll, Peter R.
关键词：
目前还没有足够的随机试验比较局限性前列腺癌的积极治疗方式。我们分析了接受根治性乳腺癌切除术、外束放射治疗或原发性雄激素剥夺治疗的男性的风险调整癌症特异性死亡率结局。CaPSURE登记研究包括来自40个泌尿外科实践场所的男性，这些男性在统一的方案下进行前瞻性随访，不考虑治疗。对7538例男性局限性疾病进行了分析。前列腺癌的风险评估使用Kestival术前诺模图和前列腺癌风险评估（CAPRA）评分，这两种工具都是根据诊断时的临床数据计算的。构建了参数生存模型，以比较不同治疗的结局，并对风险和年龄进行调整。226名男性在随访期间死于前列腺癌。校正年龄和风险后，放射治疗与睾丸切除术的癌症特异性死亡率风险比为2.21（1.50-3.24），雄激素剥夺治疗为3.22（2.16-4.81）。对于低风险的男性，直肠癌切除术和放射治疗之间的绝对差异很小，但对于中风险和高风险的男性，差异显著增加。这些结果对各种不同的分析技术都是稳健的，包括竞争风险回归分析，CAPRA而不是Kesterday评分的调整，以及总生存期作为终点的检查。与放疗或雄激素剥夺单药治疗相比，前列腺切除术治疗局限性前列腺癌可显著降低死亡率。虽然不是随机研究，但考虑到多次调整和敏感性分析，未测量的混杂因素不太可能解释观察到的生存期差异。
No adequate randomized trials comparing active treatment modalities for localized prostate cancer have been reported. We analyzed risk-adjusted cancer-specific mortality outcomes among men undergoing radical prostatectomy, external-beam radiation therapy, or primary androgen deprivation therapy. The CaPSURE registry comprises men from 40 urologic practice sites followed prospectively under uniform protocols, regardless of treatment. 7538 men with localized disease were analyzed. Prostate cancer risk was assessed using the Kattan preoperative nomogram and the Cancer of the Prostate Risk Assessment (CAPRA) score, both well-validated instruments calculated from clinical data at the time of diagnosis. A parametric survival model was constructed to compare outcomes across treatments, adjusting for risk and age. 226 men died of prostate cancer during followup. Adjusting for age and risk, the hazard ratio for cancer-specific mortality relative to prostatectomy was 2.21 (1.50–3.24) for radiation, and 3.22 (2.16–4.81) for androgen deprivation. Absolute differences between prostatectomy and radiation therapy were small for men at low risk, but increased substantially for men at intermediate and high risk. These results were robust to a variety of different analytic techniques including competing risks regression analysis, adjustment by CAPRA rather than Kattan score, and examination of overall survival as the endpoint. Prostatectomy for localized prostate cancer was associated with a significant and substantial reduction in mortality relative to radiation or androgen deprivation monotherapy. Although not a randomized study, given the multiple adjustments and sensitivity analyses it is unlikely that unmeasured confounding would account for the large observed differences in survival.
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