Brachytherapy-Based Radiotherapy and Radical Prostatectomy Are Associated With Similar Survival in High-Risk Localized Prostate Cancer
| Autor: | Liangyuan Hu, Joyce Lin, Ronald D. Ennis, Madhu Mazumdar, Shannon N. Ryemon |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Oncology Cancer Research Prognostic variable medicine.medical_specialty Databases Factual medicine.medical_treatment Brachytherapy 030232 urology & nephrology Kaplan-Meier Estimate 03 medical and health sciences Prostate cancer 0302 clinical medicine Risk Factors Internal medicine medicine Humans External beam radiotherapy Survival rate Aged Prostatectomy business.industry Prostatic Neoplasms Cancer Middle Aged medicine.disease United States Survival Rate Radiation therapy Treatment Outcome 030220 oncology & carcinogenesis Female Neoplasm Grading business |
| Zdroj: | Journal of Clinical Oncology. 36:1192-1198 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | Purpose There are no randomized trials to guide treatment decisions between radiotherapeutic and surgical options for patients with high-risk localized prostate cancer. Comparative studies have been limited by their ability to match patients on the basis of pretreatment prognostic variables and to adjust for the cancer-related, medical, and socioeconomic differences between patients who choose radiotherapeutic or surgical approaches. Methods We analyzed the outcome of all patients in the National Cancer Database with high-risk, clinically localized prostate cancer with complete prognostic data who were treated with either radical prostatectomy (RP), external beam radiotherapy (EBRT) combined with androgen deprivation (AD), or EBRT plus brachytherapy with or without AD. Inverse probability of treatment weighting was used to adjust for covariable imbalance among treatment groups. The weighted time-dependent Cox proportional hazards model was then used to estimate the effects of treatment groups on survival, accounting for differential treatment initiation times. A predictive model of pathologic nodal (pLN) status was built using prostate-specific antigen level, Gleason score, and clinical T stage; predicted pLN status was used to repeat the inverse probability of treatment weighting and time-dependent Cox proportional hazards model. Results A total of 42,765 patients were analyzed. There was no statistically significant difference in survival between RP and EBRT plus brachytherapy with or without AD (hazard ratio [HR], 1.17; 95% CI, 0.88 to 1.55). However, EBRT plus AD was associated with higher mortality than RP (HR, 1.53; 95% CI, 1.22 to 1.92). Adjustment for predicted pLN status did not yield statistically different results. A sensitivity analysis showed that EBRT plus AD ≥ 7920 cGy narrowed the difference, but a significantly higher mortality remained (HR, 1.33; 95% CI, 1.05 to 1.68). Conclusion After comprehensively adjusting for imbalances in prostate cancer prognostic factors, other medical conditions, and socioeconomic factors, this analysis showed no statistical difference in survival between patients treated with RP versus EBRT plus brachytherapy with or without AD. EBRT plus AD was associated with lower survival. |
| Databáze: | OpenAIRE |
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