Front Oncol:基于SEER数据库比较前列腺癌根治术(PR)和放疗(RT)治疗转移性前列腺癌的生存结果

2021-11-27 yd2015 MedSci原创

研究表明,对于原发肿瘤特征良好的mPCa患者,RP比RT具有更好的生存结果,但对于较晚期的患者则没有

局部治疗(LT)对选择性转移性前列腺癌(mPCa)患者的疗效已经得到证实。然而,不同LT治疗之间的效果尚不清楚。近期,国内团队基于SEER数据库开展了相关研究,比较了根治性前列腺切除术(RP)和近距离放疗(RT)对mPCa患者生存结果的影响。相关结果发表在Frontiers in Oncology杂志上。

研究者从SEER数据库中筛查2004年至2016年接受RT或RP的mPCa患者。多变量Cox比例风险分析用于评估LT之间前列腺癌特异性死亡率(CSM)和全因死亡率(ACM)的比较风险。采用1:1倾向评分匹配(PSM)和调整标准化死亡率加权(SMRW)来平衡各组的临床病理特征。

PSM前,RT组有203例,RP组481例。相对于RP组(63岁),RT组的患者年龄更大(68岁)。RT组(83.2%)的≤T2期患者比例高于RP组(34.9%)。RP组Gleason评分≥7分的患者较高(90.9%)。接受RP的患者比接受RT的患者有更大比例的M1a疾病(17.3% vs. 8.9%)。此外,与RT组相比,RP组的患者接受了更广泛的治疗(p<0.001)。PSM后,两组的临床病理特征均平衡。

在非匹配队列中,Cox比例风险模型显示两组CSM或ACM之间没有显著差异(CSM: HR = 0.86, 95% CI = 0.57 1.27, p = 0.444;ACM: HR = 0.78, 95%CI = 0.56 1.09, p = 0.148)。在PSM队列,两组CSM或ACM风险之间也没有统计学差异(CSM: HR = 0.77, 95%CI 0.46-1.30, p = 0.325 ACM: HR = 0.73, 95%CI = 0.48 -111, p = 0.138)。结果与SMRW模型的一致(CSM: HR = 0.83, 95%CI = 0.53 ~ 1.32, p = 0.435;ACM: HR = 0.75, 95%CI = 0.52-1.09, p = 0.123)。

                  预后分析

Kaplan-Meier生存曲线显示,PSM前RP与RT组的10年生存率分别为:CSS为70.5% vs. 56.7%,OS为55.8% vs. 37.0%。PSM后,RT与RT的10年CSS发生率分别为73.8%和66.7%。10年OS率分别为60.8%和45.6.0%。

           PSM前后CSS和OS对比

在亚组分析中,T1-2亚组患者中PR治疗与较低的CSM相关(HR = 0.42, 95%CI = 0.17-0.99, p = 0.048)。在GS≤7和PSA≤20 ng/ml亚组患者中,两组的CSM差异接近有统计学意义(HR = 0.30, 95%CI = 0.08 ~ 1.05, p = 0.058;HR = 0.41, 95%CI = 0.16-1.01, p = 0.053)。然而,分析显示,在T3 - 4、GS>7、PSA> 20ng /ml和所有M分期亚组患者中,两组间的CSM发生率相似。对于ACM,T1-2和PSA≤20 ng/ml亚组患者中PR治疗效果更好(T 1-2: HR = 0.55, 95%CI = 0.32 ~ 0.95, p = 0.031;PSA≤20 ng/ml: HR = 0.48, 95%CI = 0.36-0.90, p = 0.022)。在GS≤7病的患者中,RP组有降低ACM的倾向(HR = 0.079, 95%CI = 0.47 ~ 1.33, p = 0.057)。此外,RT和RP在T3 - 4、GS>7、PSA>20ng /ml和所有M分期亚组患者中表现相当。

            亚组分析

综上,研究表明,对于原发肿瘤特征良好的mPCa患者,RP比RT具有更好的生存结果,但对于较晚期的患者则没有。

原始出处:

Guo X, Xia H, Su X, Hou H, Zhong Q and Wang J (2021) Comparing the Survival Outcomes of Radical Prostatectomy Versus Radiotherapy for Patients With De Novo Metastasis Prostate Cancer: A Population-Based Study. Front. Oncol. 11:797462. doi: 10.3389/fonc.2021.797462

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    2022-05-23 minlingfeng
  2. 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    2022-03-22 sjx

    作者如何得到局部治疗相关信息呢

    0

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    2022-02-17 ms8000000275900885

    Great

    0

  4. 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  5. 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topicName=根治术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=03a52234941, createdName=bluefate122, createdTime=Mon Nov 29 10:56:10 CST 2021, time=2021-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1586271, encodeId=723c15862e1f6, content=<a href='/topic/show?id=38f8622191b' target=_blank style='color:#2F92EE;'>#根治#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62219, encryptionId=38f8622191b, topicName=根治)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26d917348678, createdName=jeanqiuqiu, createdTime=Mon Nov 29 10:56:10 CST 2021, time=2021-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1986571, encodeId=2e9019865e174, content=<a href='/topic/show?id=5822325417e' target=_blank style='color:#2F92EE;'>#前列腺癌根治术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32541, encryptionId=5822325417e, topicName=前列腺癌根治术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=bugit, createdTime=Sun Nov 06 13:56:10 CST 2022, time=2022-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074639, encodeId=40f810e46398b, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210804/0545e6ed838c4784a6874e7fd56d963a/8bf58a6c81744149b7e525aac4edf223.jpg, createdBy=28c32353383, createdName=122b6ec4m81暂无昵称, createdTime=Sat Nov 27 21:58:32 CST 2021, time=2021-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074632, encodeId=17ab10e4632e3, content=坚持学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210313/9df56058b3964a8cac82563f95f0389d/c1b478592e8e4463bef44d32712e98fd.jpg, createdBy=ea905324251, createdName=SR~young海东, createdTime=Sat Nov 27 21:46:59 CST 2021, time=2021-11-27, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1866377, encodeId=469418663e79b, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Mon May 23 07:56:10 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1204820, encodeId=a4641204820d1, content=作者如何得到局部治疗相关信息呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d32f1968310, createdName=sjx, createdTime=Tue Mar 22 07:42:30 CST 2022, time=2022-03-22, status=1, ipAttribution=), 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topicName=根治术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=03a52234941, createdName=bluefate122, createdTime=Mon Nov 29 10:56:10 CST 2021, time=2021-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1586271, encodeId=723c15862e1f6, content=<a href='/topic/show?id=38f8622191b' target=_blank style='color:#2F92EE;'>#根治#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62219, encryptionId=38f8622191b, topicName=根治)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26d917348678, createdName=jeanqiuqiu, createdTime=Mon Nov 29 10:56:10 CST 2021, time=2021-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1986571, encodeId=2e9019865e174, content=<a href='/topic/show?id=5822325417e' target=_blank style='color:#2F92EE;'>#前列腺癌根治术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32541, encryptionId=5822325417e, topicName=前列腺癌根治术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=bugit, createdTime=Sun Nov 06 13:56:10 CST 2022, time=2022-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074639, encodeId=40f810e46398b, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210804/0545e6ed838c4784a6874e7fd56d963a/8bf58a6c81744149b7e525aac4edf223.jpg, createdBy=28c32353383, createdName=122b6ec4m81暂无昵称, createdTime=Sat Nov 27 21:58:32 CST 2021, time=2021-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074632, encodeId=17ab10e4632e3, content=坚持学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210313/9df56058b3964a8cac82563f95f0389d/c1b478592e8e4463bef44d32712e98fd.jpg, createdBy=ea905324251, createdName=SR~young海东, createdTime=Sat Nov 27 21:46:59 CST 2021, time=2021-11-27, status=1, ipAttribution=)]
  7. 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GetPortalCommentsPageByObjectIdResponse(id=1194492, encodeId=56f111944920d, content=Great , beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09ee5409222, createdName=ms8000000275900885, createdTime=Thu Feb 17 16:31:06 CST 2022, time=2022-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386889, encodeId=b70c1386889ac, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93399, encryptionId=f08293399f9, topicName=转移性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Mon Nov 29 10:56:10 CST 2021, time=2021-11-29, status=1, ipAttribution=), 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topicName=根治术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=03a52234941, createdName=bluefate122, createdTime=Mon Nov 29 10:56:10 CST 2021, time=2021-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1586271, encodeId=723c15862e1f6, content=<a href='/topic/show?id=38f8622191b' target=_blank style='color:#2F92EE;'>#根治#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62219, encryptionId=38f8622191b, topicName=根治)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26d917348678, createdName=jeanqiuqiu, createdTime=Mon Nov 29 10:56:10 CST 2021, time=2021-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1986571, encodeId=2e9019865e174, content=<a href='/topic/show?id=5822325417e' target=_blank style='color:#2F92EE;'>#前列腺癌根治术#</a>, beContent=null, objectType=article, channel=null, 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level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210313/9df56058b3964a8cac82563f95f0389d/c1b478592e8e4463bef44d32712e98fd.jpg, createdBy=ea905324251, createdName=SR~young海东, createdTime=Sat Nov 27 21:46:59 CST 2021, time=2021-11-27, status=1, ipAttribution=)]
    2021-11-29 jeanqiuqiu
  8. 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    2021-11-27 122b6ec4m81暂无昵称

    厉害

    0

  10. 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    2021-11-27 SR~young海东

    坚持学习

    0

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