Recommendations for Post-Prostatectomy Radiation Therapy in the United States Before and After the Presentation of Randomized Trials
Recommendations for Post-Prostatectomy Radiation Therapy in the United States Before and After the Presentation of Randomized Trials
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DOI：
10.1016/j.juro.2010.08.086
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发表时间：
2011-01-01
影响因子：
6.6
通讯作者：
D'Amico, Anthony V.
中科院分区：
文献类型：
--
作者：
Hoffman, Karen E.;Nguyen, Paul L.;D'Amico, Anthony V.
目的：2004年和2005年的EORTC 22911和SWOG 8794研究表明，直肠癌切除术后的辅助放疗改善了具有不良病理特征的男性的生化无病生存率。在这项研究中，我们评估了这些结果的介绍，以及边缘参与，病理肿瘤分期，Gleason评分和社会人口因素对直肠癌切除术后放射治疗建议的影响后直肠癌切除术放射治疗的使用。材料和方法：SEER癌症登记处用于识别21，917例因N 0 M0前列腺癌而接受根治性前列腺切除术并伴有不良病理特征的男性（pT 3或边缘阳性pT 2疾病）。结果：在多变量回归模型中调整了年龄、诊断年份、种族、SEER地区和县教育水平后，切缘受累和Gleason 8 - 10的癌症与接受直肠癌切除术后放射治疗相关（所有p < 0.001）。患有pT 3a（AOR 2.95，CI 2.64-3.29）和pT 3b疾病（AOR 6.77，CI 5.75-7.97）的男性比患有pT 2疾病的男性更可能接受直肠癌切除术后放射治疗。在研究结果公布后，直肠癌切除术后放射治疗的使用并没有增加（p = 0.166）。虽然有累及边缘和更具侵袭性病理疾病特征的男性更有可能接受膀胱切除术后放射治疗，但在随机试验的初步报告后，膀胱切除术后放射治疗的建议并没有增加，也许是因为这些研究最初报道了改善的生化无病生存期，但不是总生存期。最近关于SWOG试验中辅助放射治疗的生存益处的报道是否会影响护理模式需要进一步随访。
Purpose: The EORTC 22911 and the SWOG 8794 studies, presented in 2004 and 2005, showed that adjuvant radiation therapy after prostatectomy improved biochemical disease-free survival in men with adverse pathological features. In this study we evaluated the use of post-prostatectomy radiation therapy following the presentation of these results, and the impact of margin involvement, pathological tumor stage, Gleason score and sociodemographic factors on post-prostatectomy radiation therapy recommendations.Materials and Methods: The SEER cancer registry was used to identify 21,917 men who underwent radical prostatectomy for N0M0 prostate cancer with adverse pathological features (pT3 or margin positive pT2 disease) from 2000 through 2007.Results: After adjusting for age, diagnosis year, race, SEER region and county education level in a multivariable regression model, decreasing age, margin involvement and Gleason 8 to 10 cancer were associated with receiving post-prostatectomy radiation therapy (all p < 0.001). Men with pT3a (AOR 2.95, CI 2.64-3.29) and pT3b disease (AOR 6.77, CI 5.75-7.97) were more likely to receive post-prostatectomy radiation therapy than those with pT2 disease. The use of post-prostatectomy radiation therapy did not increase after the presentation of study results (p = 0.166).Conclusions: While men with involved margins and more aggressive pathological disease features were more likely to receive post-prostatectomy radiation therapy, recommendations for post-prostatectomy radiation did not increase after the initial reports from the randomized trials, perhaps because these studies initially reported improved biochemical disease-free survival but not overall survival. Whether the recent report of a survival benefit from adjuvant radiation therapy in the SWOG trial will impact patterns of care requires further followup.