Definitive Radiation Therapy and Survival in Clinically Node-Positive Prostate Cancer
| Autor: | Andrew Karim Kader, Jason A. Efstathiou, James D. Murphy, Rana R. McKay, Alex K. Bryant, Brent S. Rose, John P. Einck, Christopher J. Kane, Arno J. Mundt, Loren K. Mell |
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| Rok vydání: | 2017 |
| Předmět: |
Oncology
Male Cancer Research Aging Time Factors Databases Factual medicine.medical_treatment 030218 nuclear medicine & medical imaging Androgen deprivation therapy Cohort Studies Prostate cancer 0302 clinical medicine Prostate Medicine Neoplasm Metastasis Veterans Cancer Radiation Prostate Cancer Incidence Hazard ratio Middle Aged Hospitals Other Physical Sciences medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Lymphatic Metastasis Patient Safety Urologic Diseases medicine.medical_specialty Hospitals Veterans Clinical Sciences Oncology and Carcinogenesis Disease-Free Survival 03 medical and health sciences Databases Statistical significance Internal medicine Humans Radiology Nuclear Medicine and imaging Oncology & Carcinogenesis Veterans Affairs Factual Aged Proportional Hazards Models business.industry Proportional hazards model Prostatic Neoplasms Androgen Antagonists Prostate-Specific Antigen medicine.disease Confidence interval Radiation therapy Good Health and Well Being Multivariate Analysis Lymph Nodes business |
| Zdroj: | International journal of radiation oncology, biology, physics, vol 101, iss 5 Bryant, AK; Kader, AK; McKay, RR; Einck, JP; Mell, LK; Mundt, AJ; et al.(2018). Definitive Radiation Therapy and Survival in Clinically Node-Positive Prostate Cancer. INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 101(5), 1188-1193. doi: 10.1016/j.ijrobp.2018.04.023. UC San Diego: Retrieved from: http://www.escholarship.org/uc/item/3v9686cs |
| ISSN: | 1879-355X |
| Popis: | 168 Background: The survival benefit of combined radiation therapy (RT) and androgen deprivation therapy (ADT) compared to ADT alone for clinically lymph node-positive prostate cancer remains controversial. Methods: We identified clinically node-positive, non-metastatic prostate cancer patients diagnosed between 2000-2015 and treated with ADT (n = 450) or ADT/RT (n = 198) from a national Veterans Affairs database. We compared prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) between treatment groups using multivariable Cox regression, controlling for potential confounders. All tests of statistical significance were two sided. Results: Compared to ADT alone, ADT/RT was associated with improved ACM (hazard ratio [HR]: 0.56, 95% CI 0.41-0.76, p < 0.001) and PCSM overall (HR 0.65, 95% CI 0.43-0.97, p = 0.03). We noted a significant interaction between ADT/RT and pre-treatment PSA for PCSM (p for interaction = 0.005) and ACM (p for interaction < 0.001). ADT/RT was associated with improved PCSM among patients with PSA less than (HR 0.43, 95% CI 0.24-0.78, p = 0.004) but not greater than the median of 26 ng/mL (HR 1.01, 95% CI 0.60-1.71, p = 0.96). ADT/RT was also associated with improved ACM among patients with PSA less than (HR 0.38, 95% CI 0.25-0.57, p < 0.001) but not greater than the median (HR 0.91, 95% CI 0.60-1.38, p = 0.66). Conclusions: Definitive treatment with ADT/RT is associated with improved ACM and PCSM among patients with clinically node-positive prostate cancer. The survival benefit of ADT/RT is only apparent among patients with lower baseline PSA. Patients with clinically node-positive disease appear to be a heterogeneous cohort, with a subset that may achieve long-term survival with combined radiation and androgen deprivation therapy. |
| Databáze: | OpenAIRE |
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