Optimizing Time to Treatment to Achieve Durable Biochemical Disease Control after Surgery in Prostate Cancer: A Multi-Institutional Cohort Study.
Optimizing Time to Treatment to Achieve Durable Biochemical Disease Control after Surgery in Prostate Cancer: A Multi-Institutional Cohort Study.
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DOI：
10.1158/1055-9965.epi-18-0812
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发表时间：
2019-03
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影响因子：
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通讯作者：
Yamoah K
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作者：
Awasthi S;Gerke T;Park JY;Asamoah FA;Williams VL;Fink AK;Balkrishnan R;Lee DI;Malkowicz SB;Lal P;Dhillon J;Pow-Sang JM;Rebbeck TR;Yamoah K
治疗延迟对前列腺癌 (PCa) 特定结果的影响仍然不明确。本研究探讨治疗时间对前列腺切除术后生化疾病控制的影响。这项回顾性研究包括 1,807 名患者，这些患者从 1987 年至 2015 年在两个大型三级转诊中心接受了前列腺切除术作为主要治疗。使用具有限制三次样条的多元 cox 模型来确定接受治疗的最佳时间并估计生化复发的风险。该研究的中位随访时间为 46 (IQR 18 – 86) 个月。根据多元三次样条 cox 模型对治疗时间进行了细分。在多变量样条模型中，调整所有相关的预处理变量后，在 3 个月左右观察到生化复发风险的拐点，该拐点在 6 个月后进一步增加。根据样条模型，治疗时间分为0-3个月（61.5%）、>3-6个月（31.1%）和6个月（7.4%）。在调整后的 cox 模型中，最初延迟长达 6 个月不会对结果产生不利影响，但是，治疗时间 > 6 个月生化复发的风险显着更高，风险比 = 1.84，95% CI，1.30 – 2.60，p < 0.01。前列腺癌主要治疗最初延迟长达 6 个月可能是可持续的，不会对结果产生不利影响。然而，超过 6 个月的显着延迟可能会对生化疾病控制产生不利影响。治疗时间可以帮助临床医生做出前列腺癌治疗建议的决策，并教育患者避免无意的治疗延误。
The impact of treatment delays on Prostate Cancer (PCa) specific outcomes remains ill-defined. This study investigates the effect of time to treatment on biochemical disease control after prostatectomy. This retrospective study includes 1,807 patients who received a prostatectomy as a primary treatment at two large tertiary referral centers from 1987 – 2015. Multivariate cox model with restricted cubic spline were used to identify optimal time to receive treatment and estimate the risk of Biochemical recurrence. Median follow up time of the study was 46 (IQR 18 – 86) months. Time to treatment was subcategorized based on multivariate cubic spline cox model. In multivariate spline model, adjusted for all the pertinent pretreatment variables, inflection point in the risk of biochemical recurrence was observed around 3 month which further increased after 6 months. Based on spline model, time to treatment was then divided into 0–3 months (61.5%), >3–6 months (31.1%) and 6 months (7.4%). In the adjusted cox model, initial delays up to 6 months did not adversely affect the outcome, however, time to treatment >6 month had significantly higher risk of biochemical recurrence, Hazard Ratio = 1.84, 95% CI, 1.30 – 2.60, p < 0.01. The initial delays up to 6 months in prostate cancer primary treatment may be sustainable without adversely affecting the outcome. However, significant delays beyond 6 months can unfavorably impact biochemical disease control. Time to treatment can aide clinicians in the decision making of PCa treatment recommendation and educate patients against unintentional treatment delays.