Improvement in Prostate Cancer Survival Over Time A 20-Year Analysis
Improvement in Prostate Cancer Survival Over Time A 20-Year Analysis
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DOI：
10.1097/ppo.0b013e3182467419
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发表时间：
2012-01-01
期刊：
影响因子：
2.2
通讯作者：
Kuban, Deborah A.
中科院分区：
文献类型：
--
作者：
Kim, Michelle M.;Hoffman, Karen E.;Kuban, Deborah A.
目的：本研究旨在评估20年间在综合癌症中心接受明确外束放射治疗的局限性前列腺癌患者预后的变化。方法：我们将2675名在MD安德森癌症中心接受明确外束放射治疗的前列腺癌患者分为三个治疗时期：1987年至1993年（n = 722）， 1994年至1999年（n = 828）， 2000年至2007年（n = 1125）。为了帮助调整阶段迁移，根据国家综合癌症网络定义的风险组对患者进行分层。根据Kaplan-Meier方法分析生化（Phoenix定义）、局部、远处和任何临床失败、前列腺癌特异性生存和总生存。结果：中位年龄68.5岁，中位随访6.4年。在最近的一个时代，患高危疾病的男性减少了，接受72戈瑞或更高的治疗的比例（99%对4%）和雄激素剥夺治疗的比例（60%对6%）比最早的时代更高。所有在现代接受治疗的风险群体的生化、局部和远处失败率都有所提高。在高危患者中，远端失败和临床失败的降低导致前列腺癌特异性生存率和总生存率的提高。中高危患者的局部控制得到改善，低危患者有改善的趋势。在多变量分析中，最近的治疗时间与72gy或更高的剂量和雄激素剥夺治疗密切相关，并预测生化、局部和远处失败率较低。雄激素剥夺治疗，更高的剂量，更近期的治疗预测提高前列腺癌特异性生存率。讨论：在过去20年的前列腺癌放疗中，所有患者的疾病控制结果都得到了改善，导致前列腺癌特异性生存和高危男性的总体生存得到改善。这可能反映了现代前列腺癌在检查、分期准确性和治疗方面的进步。
Purpose: This study aimed to evaluate the changes in outcome for men with localized prostate cancer treated with definitive external beam radiation therapy during a 20-year period at a comprehensive cancer center.Methods: We categorized 2675 men with prostate cancer treated at MD Anderson Cancer Center with definitive external beam radiation therapy with or without androgen deprivation therapy into 3 treatment eras: 1987 to 1993 (n = 722), 1994 to 1999 (n = 828), and 2000 to 2007 (n = 1125). To help adjust for stage migration, patients were stratified according to risk group as defined by the National Comprehensive Cancer Network. Biochemical (Phoenix definition), local, distant, and any clinical failure, prostate-cancer specific survival, and overall survival were analyzed according to the Kaplan-Meier method.Results: Median age was 68.5 years and median follow-up was 6.4 years. Fewer men in the most recent era had high-risk disease, and a higher proportion received 72 Gy or higher (99% vs 4%) and androgen deprivation therapy (60% vs 6%) than the earliest era. All risk groups treated in the modern era experienced improved rates of biochemical, local, and distant failure. In high-risk patients, decreased rates of distant failure and clinical failure led to improved prostate cancer-specific survival and overall survival. Local control was improved for intermediate-and high-risk patients, with a trend toward improvement in low-risk patients. On multivariate analysis, recent treatment era was closely correlated with a dose of 72 Gy or higher and treatment with androgen deprivation therapy and predicted for lower rates of biochemical, local, and distant failure. Androgen deprivation therapy, higher dose, and more recent treatment era predicted for improved prostate cancer-specific survival.Discussion: During the last 20 years of prostate cancer irradiation, disease control outcomes have improved in all patients, leading to improved prostate cancer-specific survival and overall survival for men with high-risk disease. This may reflect advances in workup, staging accuracy, and prostate cancer treatment in the modern era.