J Urol:在高危和极高危前列腺癌患者中,根治性前列腺切除术与放射治疗哪个生存率更高?

2021-10-18 AlexYang MedSci原创

在美国国家综合癌症网络(NCCN)高危(HR)患者以及约翰霍普金斯大学(JH)高危(HR)和极高危(VHR)亚组中,比较了前列腺根治术(RP)与体外放疗(EBRT)的癌症特异性死亡率(CSM)情况。

根据美国国家综合癌症网络(NCCN)的定义,17%至31%的新诊断临床局部前列腺癌归类为高危(Gleason 8-10,或PSA>20 ng/ml,或临床分期≥T3)。根据约翰霍普金斯大学(Johns Hopkins University)的标准,在NCCN高危(HR)患者中,分别有85%和15%的患者归类为高危(至少存在以下标准之一:cT3a或格里森等级组(GGG)IV/V或PSA>20ng/ml)与极高危(VHR)(至少存在以下标准之一:0cT3b-cT4和/或原发Gleason模式5和/或2-3个高危特征和/或≥5个GGG IV/V的阳性活检核心)。

值得注意的是,当使用JH标准时,与HR患者相比,VHR患者显往往显示出更差的肿瘤学结果(生化复发、无转移生存率和癌症特异性死亡率)。在治愈性治疗中,JH HR和VHR患者均可接受RP或EBRT治疗。然而,据研究人员所知,目前还没有大规模的、基于人群的分析来调查哪种治疗方式在癌症特异性死亡率(CSM)方面具有优势,特别是在JH HR或VHR患者中

 

近期,来自意大利的研究人员在《J Urol》上发表文章,他们在美国国家综合癌症网络(NCCN)高危(HR)患者以及约翰霍普金斯大学(JH)高危(HR)和极高危(VHR)亚组中,比较了前列腺根治术(RP)与体外放疗(EBRT)的癌症特异性死亡率(CSM)情况

在监测、流行病学和最终结果数据库(2010-2016年)中,研究人员确定了24407名NCCN HR患者,其中有10300名(42%)与14107名(58%)患者分别符合JH HR和VHR标准。总体而言,9823人(40%)接受了RP,而14584人(60%)接受了EBRT。在RP和EBRT患者之间进行1:1倾向性评分匹配后(根据年龄、PSA、临床T和N期以及活检Gleason评分),使用累积发病率和竞争风险回归评估CSM。

合并NCCN高危前列腺癌患者中,RP与EBRT的CSM情况

结果发现,在合并的NCCN HR队列中,RP的5年CSM率为2.3%,EBRT为4.1%,多变量危险比(HR)为0.68,95%置信区间(CI)为0.54-0.86,P <0.001),结果有利于RP。在VHR患者中,RP的5年CSM率为3.5%,EBRT为6.0%,多变量HR为0.58(95%CI为0.44-0.77,P<0.001),结果也是有利于RP。然而,在HR患者中,RP与EBRT之间没有显著差异(HR 0.7,95% CI 0.39-1.25,p=0.2)。

JH极高危前列腺患者亚组中RP与EBRT的CSM情况

综上所述,研究数据表明,在合并的NCCN HR队列中以及在其JH VHR患者亚组中,RP的CSM比EBRT有优势

原始出处:

Francesco Chierigo , Mike Wenzel , Christoph Würnschimmel et al. Survival after Radical Prostatectomy vs. Radiation Therapy in High-Risk and Very High-Risk Prostate Cancer. J Urol. Sep 2021

 

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