External-Beam Radiotherapy for Clinically Localized Prostate Cancer in Osaka, Japan, 1995-2006 Time Trends, Outcome, and Risk Stratification
External-Beam Radiotherapy for Clinically Localized Prostate Cancer in Osaka, Japan, 1995-2006 Time Trends, Outcome, and Risk Stratification
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DOI：
10.1007/s00066-009-1981-0
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发表时间：
2009-07-01
影响因子：
3.1
通讯作者：
Inoue, Takehiro
中科院分区：
文献类型：
--
作者：
Yoshioka, Yasuo;Suzuki, Osamu;Inoue, Takehiro
目的：建立日本大阪临床局限性前列腺癌体外放射治疗(EBRT)的初步数据库，并通过分析大阪多中心合作研究的结果，确定现有和作者提出的风险分层方法的时间趋势、结果和适用性。这些患者从1995年到2006年在大阪的11家机构接受了连续的最终EBRT治疗，治疗剂量为>；=60Gy.总共有436名患者有资格使用几种风险分层方法进行分析，即D‘Amico等人、国家癌症综合网络(NCCN)和西雅图的风险分层方法，以及作者最初的前列腺癌风险指数(Prix)。结果：患者数量在10年内增加了10倍，同时Gleason评分的使用从0%迅速扩大到90%。放疗剂量以70Gy35次为主(87%)。95%的患者接受了激素治疗，Prix越高，激素使用率越高。3年和5年生化无复发生存率(BRFs)分别为85%和70%。D‘Amico(p=0.132)、NCCN(p=0.138)、Seattle(p=0.041)和Prix(p=0.044)分类与BRFs的相关性较弱或不相关，而改良的三级Prix(Prix 0、1-5、6)与BRFs有较强的相关性(p=0.002)。考虑到适中的RT剂量，短期结果令人满意。非常高的激素使用率可能会对结果产生有利影响，但也可能会损害当前风险分层的有效性。
Purpose: To establish an initial database of external-beam radiotherapy (EBRT) for clinically Localized prostate cancer used in Osaka, Japan, and, by analyzing the results of the Osaka multicenter cooperative study, to determine time trends, outcome, and applicability of existing and the authors' original risk stratification methods.Patients and Methods: Data of 652 patients with clinically localized prostate cancer (T1-4 N0 M0) were accrued from July to December 2007. These patients had been treated from 1995 through 2006 with consecutive definitive EBRT of >= 60 Gy at eleven institutions, mainly in Osaka. Altogether, 436 patients were eligible for analysis using several risk stratification methods, namely, those of D'Amico et al., the National Comprehensive Cancer Network (NCCN), and Seattle, as well as the authors' original Prostate Cancer Risk Index (PRIX).Results: The number of patients showed a tenfold increase over 10 years, together with a rapid spread of the use of Gleason Score from 0% to > 90% of cases. The dominant RT dose fractionation was 70 Gy/35 fractions (87%). Hormone therapy had been administered to 95% of the patients and the higher PRIX corresponded to the higher rate of hormone usage. 3- and 5-year biochemical relapse-free survival (bRFS) rates were 85% and 70%, respectively. The D'Amico (p = 0.132), NCCN (p = 0.138), Seattle (p = 0.041) and PRIX (p = 0.044) classifications showed weak or no correlation with bRFS, white the own modified three-class PRIX (PRIX 0, 1-5, 6) showed a strong correlation (p = 0.002).Conclusion: The use of prostate EBRT in Japan is still in its infancy, but is rapidly expanding. The short-term outcomes have been satisfactory considering the moderate RT dose. A very high rate of hormone usage may affect the outcome favorably, but also may compromise the usefulness of current risk stratification.