Outcomes after definitive radiation therapy for localized prostate cancer in a national health care delivery system.
Outcomes after definitive radiation therapy for localized prostate cancer in a national health care delivery system.
复制标题
在国家医疗保健服务系统中对局限性前列腺癌进行明确放射治疗后的结果。
作者：
Herr,DanielJ;Elliott,DavidA;Duchesne,Gillian;Stensland,KristianD;Caram,MeganEV;Chapman,Christina;Burns,JenniferA;Hollenbeck,BrentK;Sparks,JordanB;Shin,Chris;Zaslavsky,Alexander;Tsodikov,Alexander;Skolarus,TedA
目的有关局部前列腺癌当代放射治疗后真实世界结果的准确信息对于共同决策非常重要。对在国家医疗保健服务系统内接受治疗的男性 10 岁时的临床相关终点进行了检查。方法使用国家行政、癌症登记和电子健康记录数据来研究 2005 年至 2015 年在退伍军人健康管理局内接受明确放射治疗并同时进行或不进行雄激素剥夺治疗的患者。使用国家死亡指数数据来了解 2019 年的总体生存率和前列腺癌特异性生存率以及转移性前列腺事件的确定日期 使用经过验证的自然语言处理算法来治疗癌症。使用 Kaplan-Meier 方法估计无转移、前列腺癌特异性和总体生存率。结果在 41,735 名接受明确放射治疗的男性中，诊断时的中位年龄为 65 岁，中位随访时间为 8.7 年。大多数人患有中危（42%）和高危（33%）疾病，其中 40% 接受雄激素剥夺治疗作为初始治疗的一部分。低风险、中风险和高风险疾病的未经调整的 10 年无转移生存率分别为 96%、92% 和 80%。同样，低风险、中风险和高风险疾病的未经调整的 10 年前列腺癌特异性生存率分别为 98%、97% 和 90%。在不断增加的疾病风险类别中，低风险、中风险和高风险疾病的未经调整的总生存率较低，分别为 77%、71% 和 62% (p<0.001)。结论这些数据为使用当代技术接受放射治疗的局限性前列腺癌患者提供了基于人群的临床相关终点的 10 年基准，包括无转移生存率。高风险疾病的生存率尤其表明结果最近有所改善。
PurposeAccurate information regarding real‐world outcomes after contemporary radiation therapy for localized prostate cancer is important for shared decision‐making. Clinically relevant end points at 10 years among men treated within a national health care delivery system were examined.MethodsNational administrative, cancer registry, and electronic health record data were used for patients undergoing definitive radiation therapy with or without concurrent androgen deprivation therapy within the Veterans Health Administration from 2005 to 2015. National Death Index data were used through 2019 for overall and prostate cancer–specific survival and identified date of incident metastatic prostate cancer using a validated natural language processing algorithm. Metastasis‐free, prostate cancer–specific, and overall survival using Kaplan–Meier methods were estimated.ResultsAmong 41,735 men treated with definitive radiation therapy, the median age at diagnosis was 65 years and median follow‐up was 8.7 years. Most had intermediate (42%) and high‐risk (33%) disease, with 40% receiving androgen deprivation therapy as part of initial therapy. Unadjusted 10‐year metastasis‐free survival was 96%, 92%, and 80% for low‐, intermediate‐, and high‐risk disease. Similarly, unadjusted 10‐year prostate cancer–specific survival was 98%, 97%, and 90% for low‐, intermediate‐, and high‐risk disease. The unadjusted overall survival was lower across increasing disease risk categories at 77%, 71%, and 62% for low‐, intermediate‐, and high‐risk disease (p< .001).ConclusionsThese data provide population‐based 10‐year benchmarks for clinically relevant end points, including metastasis‐free survival, among patients with localized prostate cancer undergoing radiation therapy using contemporary techniques. The survival rates for high‐risk disease in particular suggest that outcomes have recently improved.