Impact of short course hormonal therapy on overall and cancer specific survival after permanent prostate brachytherapy
Impact of short course hormonal therapy on overall and cancer specific survival after permanent prostate brachytherapy
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DOI：
10.1016/j.ijrobp.2004.08.024
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发表时间：
2005-04-01
影响因子：
7
通讯作者：
Thomas, T
中科院分区：
文献类型：
--
作者：
Beyer, DC;McKeough, T;Thomas, T
目的：回顾既往激素治疗对原发性近距离放射治疗后10年总体和前列腺癌特异性生存率的影响，方法和材料：对亚利桑那州肿瘤服务肿瘤登记处1988年至2001年连续2,378例永久性前列腺近距离放射治疗病例进行回顾性分析。464例患者在植入前接受激素治疗，以缩小前列腺大小或由转诊医生决定。所有已知临床复发的死亡患者均被认为死于前列腺癌，无论直接死亡原因如何。风险组被定义为1，135名有利（前列腺特异性抗原[PSA] < 10，Gleason < 7，T1-T2 a期），787名中间（单一不良特征）和456名不利（两个或更多不良特征）患者。从治疗时开始，生成总生存期和病因特异性生存期的Kaplan-Meier精算生存曲线。进行多变量分析，以评估激素干预的影响，与已知的危险因素的等级，PSA，和age.Results：随访范围长达12.6年，中位数为4.1年，共有474例患者死亡，67记录为由于前列腺癌。总体和病因特异性10年生存率分别为43%和88%。激素初治患者的总生存率为44%，而激素治疗组为20%（p = 0.02）。癌症特异性生存率为89%，而相同组为81%（p = 0.133）。多变量分析证实了年龄> 70岁（p = 0.0013），Gleason评分2：7（p = 0.0005）和既往激素使用（p = 0.0065）对总生存率的意义。结论：在10年时，接受近距离放射治疗的前列腺癌患者中，接受新辅助激素治疗的男性的总生存率低于未接受激素治疗的患者。这似乎不是由于其他已知的生存风险因素（即，分期、分级、PSA、年龄）。死亡的主要原因是心血管、前列腺癌和其他癌症，两组之间没有明显差异。这一发现是出乎意料的，需要其他中心的确认。(c)2004年爱思唯尔公司
Purpose: To review the impact of prior hormonal therapy on 10-year overall and prostate cancer specific survival after primary brachytherapy.Methods and Materials: A retrospective review was performed on the Arizona Oncology Services tumor registry for 2,378 consecutive permanent prostate brachytherapy cases from 1988 through 2001. Hormonal therapy was administered before the implant in 464 patients for downsizing of the prostate or at the discretion of the referring physician. All deceased patients with known clinical recurrence were considered to have died of prostate cancer, irrespective of the immediate cause of death. Risk groups were defined, with 1,135 favorable (prostate-specific antigen [PSA] < 10, Gleason < 7, Stage T1-T2a), 787 intermediate (single adverse feature), and 456 unfavorable (two or more adverse features) patients. Kaplan-Meier actuarial survival curves were generated for both overall and cause-specific survival from the time of treatment. Multivariate analysis was performed to assess the impact of hormonal intervention in comparison with known risk factors of grade, PSA, and age.Results: With follow-up ranging up to 12.6 years and a median of 4.1 year, a total of 474 patients died, with 67 recorded as due to prostate cancer. Overall and cause-specific 10-year survival rates are 43% and 88%, respectively. Overall survival is 44% for the hormone naive patients, compared with 20% for the hormone-treated cohort (p = 0.02). The cancer-specific survival is 89% vs. 81% for the same groups (p = 0.133). Multivariate analysis confirms the significance of age > 70 years (p = 0.0013), Gleason score 2: 7 (p = 0.0005), and prior hormone use (p = 0.0065) on overall survival.Conclusions: At 10 years, in prostate cancer patients receiving brachytherapy, overall survival is worse in men receiving neoadjuvant hormonal therapy, compared with hormone naive patients. This does not appear to be due to other known risk factors for survival (i.e., stage, grade, PSA, age) on multivariate analysis. The leading causes of death were cardiovascular, prostate cancer, and other cancers with no obvious discrepancy between the two groups. This finding is unexpected and requires confirmation from other centers. (c) 2004 Elsevier Inc.