Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer
Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer
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DOI：
10.1001/jama.280.11.969
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发表时间：
1998-09-16
影响因子：
120.7
通讯作者：
Wein, A
中科院分区：
文献类型：
--
作者：
D'Amico, AV;Whittington, R;Wein, A
背景。-间质放射（植入）治疗用于治疗临床上局限性前列腺癌，但与其他治疗方法相比如何尚不清楚。评估临床局限性前列腺癌患者行根治性前列腺切除术（RP）、外照射（RT）或植入术联合或不联合新辅助雄激素剥夺治疗后前列腺特异性抗原（PSA）的控制情况。采用考克斯回归多变量分析比较结局数据的回顾性队列研究。在1989年1月至1997年10月期间，在费城宾夕法尼亚大学医院接受RP（n = 888）或植入（n = 218）伴或不伴新辅助雄激素剥夺治疗，或在马萨诸塞州波士顿联合放射治疗中心接受RT（n = 766）治疗的1872名男性入选。精算无PSA失败（定义为PSA结局），结果。低风险患者PSA失败的相对风险（RR）使用RT、植入物加雄激素剥夺疗法或植入物疗法治疗的患者（Tie、T2 a期和PSA水平小于或等于10 ng/mL且Gleason评分小于或等于6）为1.1（95%置信区间[CI]，0.5-2.7）、0.5（95% CI，0.1-1.9）和1.1（95% CI，0.3-3.6）。中危患者PSA失败的RR（T2 b期或Gleason评分为7或PSA水平>10且小于或等于20 ng/mL）和高风险患者（T2 c期或PSA水平>20 ng/mL或Gleason评分大于或等于8）与RP相比，（95% CI，1.5-6.1）和3.0（95% CI，1.8-5.0），在植入治疗中加入雄激素剥夺治疗并未改善高危患者的PSA结局，但与在中危患者中使用RP或RT获得的结果相比，PSA结局无统计学差异。当患者使用传统的活检Gleason评分分级（2 - 4 vs 5 - 6 vs 7 vs 8 - 10）进行分层时，这些结果没有变化。低风险患者接受RP、RT或植入治疗（伴或不伴新辅助雄激素剥夺）后的5年PSA结局估计值无统计学差异，而接受RP或RT治疗的中高危患者的PSA结局优于接受植入治疗的患者，需要前瞻性随机试验来验证这些结果。
Context.-Interstitial radiation (implant) therapy is used to treat clinically localized adenocarcinoma of the prostate, but how it compares with other treatments is not known.Objective.-To estimate control of prostate-specific antigen (PSA) after radical prostatectomy (RP), external beam radiation (RT), or implant with or without neoadjuvant androgen deprivation therapy in patients with clinically localized prostate cancer.Design.-Retrospective cohort study of outcome data compared using Cox regression multivariable analyses.Setting and Patients.-A total of 1872 men treated between January 1989 and October 1997 with an RP (n = 888) or implant with or without neoadjuvant androgen deprivation therapy (n = 218) at the Hospital of the University of Pennsylvania, Philadelphia, or RT (n = 766) at the Joint Center for Radiation Therapy, Boston, Mass, were enrolled.Main Outcome Measure.-Actuarial freedom from PSA failure (defined as PSA outcome),Results.-The relative risk (RR) of PSA failure in low-risk patients (stage Tie, T2a and PSA level less than or equal to 10 ng/mL and Gleason score less than or equal to 6) treated using RT, implant plus androgen deprivation therapy, or implant therapy was 1.1 (95% confidence interval [CI], 0.5-2.7), 0.5 (95% CI, 0.1-1.9), and 1.1 (95% CI, 0.3-3.6), respectively, compared with those patients treated with RP. The RRs of PSA failure in the intermediate-risk patients (stage T2b or Gleason score of 7 or PSA level >10 and less than or equal to 20 ng/mL) and high-risk patients (stage T2c or PSA level >20 ng/mL or Gleason score greater than or equal to 8) treated with implant compared with RP were 3.1 (95% CI, 1.5-6.1) and 3.0 (95% CI, 1.8-5.0), respectively, The addition of androgen deprivation to implant therapy did not improve PSA outcome in high-risk patients but resulted in a PSA outcome that was not statistically different compared with the results obtained using RP or RT in intermediate-risk patients. These results were unchanged when patients were stratified using the traditional rankings of biopsy Gleason scores of 2 through 4 vs 5 through 6 vs 7 vs 8 through 10,Conclusions.-Low-risk patients had estimates of 5-year PSA outcome after treatment with RP, RT, or implant with or without neoadjuvant androgen deprivation that were not statistically different, whereas intermediate- and high-risk patients treated with RP or RT did better then those treated by implant, Prospective randomized trials are needed to verify these findings.