Projecting the clinical benefits of adjuvant radiotherapy versus observation and selective salvage radiotherapy after radical prostatectomy: a decision analysis.
Projecting the clinical benefits of adjuvant radiotherapy versus observation and selective salvage radiotherapy after radical prostatectomy: a decision analysis.
复制标题
DOI：
10.1038/pcan.2011.27
复制
发表时间：
2011-09
影响因子：
4.8
通讯作者：
Kuntz, K. M.
中科院分区：
文献类型：
--
作者：
Elliott, S. P.;Wilt, T. J.;Kuntz, K. M.
我们的目的是预测和比较局部晚期前列腺癌患者根治性前列腺癌根治术后辅助放射治疗(ART)和挽救放射治疗(SRT)的临床和质量调整生命年(QALY)结果。我们构建了一个马尔可夫模型来模拟观察与抗逆转录病毒治疗的随机研究，假设75%的观察患者在前列腺特异性抗原(PSA)复发时接受SRT。转移概率和效用输入来自ART的随机试验和SRT的队列研究。我们预测了10年的PSA无复发生存率、无转移生存率和总生存率。我们发现，选择性放射治疗在放疗后PSA无复发生存率(47%和52%)、无转移生存率(69%和70%)和总生存率(72%和73%)方面比ART略差。这些发现对敏感性分析很有说服力。在调整了RT的无效因素后，观察加SRT在10年时的QALY比ART更好(6.80和6.13 QALY)。因此，对于希望将治疗副作用降至最低的可能遵守监测的男性来说，观察加SRT可能是最优的。这些发现反映了在当前证据水平下普通患者的结果，并旨在帮助我们在等待未来比较有效性的临床研究时为当前的决策提供信息。
Our purpose was to project and compare clinical and quality-adjusted life year (QALY) outcomes of adjuvant radiotherapy (ART) vs. salvage radiotherapy (SRT) after radical prostatectomy for men with locally advanced prostate cancer. We constructed a Markov model to simulate the randomized studies of observation vs. ART, assuming 75% of observation patients would receive SRT at prostate specific antigen (PSA) recurrence. Transition probabilities and utility inputs were drawn from randomized trials of ART and cohort studies of SRT. We projected 10-year PSA recurrence-free survival, metastasis-free survival and overall survival. We found that observation with selective SRT yielded slightly worse outcomes than ART for post-RT PSA recurrence-free survival (47% and 52%), metastasis-free survival (69% and 70%) and overall survival (72% and 73%). Findings were robust to sensitivity analyses. After adjusting for the disutility of RT, observation plus SRT yielded better QALYs at 10 years than ART (6.80 and 6.13 QALYs). Thus, observation plus SRT may be optimal for men likely to comply with surveillance who wish to minimize treatment side effects. These findings reflect outcomes for the average patient given the current level of evidence and are meant to help inform current decision-making as we await future clinical studies of comparative effectiveness.
登录
查看更多内容
影响因子：
6.6
作者：
Swanson, Gregory P.;Goldman, Bryan;Crawford, E. David
通讯作者：
Crawford, E. David
影响因子：
2.1
作者：
Trabulsi, Edouard J.;Valicenti, Richard K.;Hanlon, Alexandra L.;Pisansky, Thomas M.;Sandler, Howard M.;Kuban, Deborah A.;Catton, Charles N.;Michalski, Jeff M.;Zelefsky, Michael J.;Kupelian, Patrick A.;Lin, Daniel W.;Anscher, Mitchell S.;Slawin, Kevin M.;Roehrborn, Claus G.;Forman, Jeffrey D.;Liauw, Stanley L.;Kestin, Larry L.;DeWeese, Theodore L.;Scardino, Peter T.;Stephenson, Andrew J.;Pollack, Alan
通讯作者：
Pollack, Alan
影响因子：
2.1
作者：
Chawla, AK;Thakral, HK;Shipley, WU
通讯作者：
Shipley, WU
影响因子：
45.3
作者：
Moinpour, Carol M.;Hayden, Katherine A.;Crawford, E. David
通讯作者：
Crawford, E. David
影响因子：
168.9
作者：
Bolla, M;van Poppel, H;Piérart, M
通讯作者：
Piérart, M