Comparison of Multimodal Therapies and Outcomes Among Patients With High-Risk Prostate Cancer With Adverse Clinicopathologic Features
| Autor: | Eyad Abu-Isa, Albert J. Chang, Wolfgang Lilleby, Jeffrey J. Tosoian, Robert E. Reiter, Brian J. Moran, Robert T. Dess, Trude B. Wedde, Theodore L. DeWeese, D. Jeffrey Demanes, Patrick A. Kupelian, Todd McNutt, Ridwan Alam, Prashant Bhat, Tahmineh Romero, Santiago Martin, Daniel E. Spratt, Thomas M. Pisansky, Nicholas G. Nickols, Giovanni Motterle, Rafael Martínez-Monge, J.K. Wong, Gregory S. Merrick, Derya Tilki, Matthew Rettig, R. Jeffrey Karnes, Jesus E. Juarez, Michael L. Steinberg, Phuoc T. Tran, Hartwig Huland, Bradley J. Stish, Eric M. Horwitz, David Elashoff, Danny Y. Song, Bruce J. Trock, Alejandro Berlin, Chandana A. Reddy, David Shabsovich, Daniel J. Krauss, Brian J. Davis, Eric A. Klein, Michelle H. Braccioforte, Curtiland Deville, Rahul D. Tendulkar, Richard G. Stock, Natalie Chong, Paul C. Boutros, Jay P. Ciezki, Jonathan D. Tward, Ryan Fiano, Rebecca Levin-Epstein, Zeyad Schwen, Richard Choo, Ashley E. Ross, Avinash Pilar, Anthony V. D'Amico, Amar U. Kishan, Stephen Greco |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Oncology
Male medicine.medical_specialty medicine.medical_treatment Brachytherapy California Androgen deprivation therapy Cohort Studies Prostate cancer Prostate Risk Factors Internal medicine Medicine Humans External beam radiotherapy Original Investigation Aged Retrospective Studies Prostatectomy Radiotherapy business.industry Research Cancer Prostatic Neoplasms Multimodal therapy General Medicine Middle Aged medicine.disease Combined Modality Therapy Online Only medicine.anatomical_structure Treatment Outcome business |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | Key Points Question Are external beam radiotherapy, with or without brachytherapy boost, or radical prostatectomy associated with differences in prostate cancer–specific mortality or distant metastasis outcomes in patients with high-risk prostate cancer after accounting for delivery of guideline-concordant multimodality therapy? Findings In this cohort study of 6004 men with high-risk prostate cancer and at least 1 additional adverse clinicopathologic feature, no differences in prostate cancer-specific mortality across treatment modalities were identified among patients who received guideline-concordant multimodality therapy, although differences in time to metastasis were observed. However, significant differences in prostate cancer–specific mortality were identified when guideline-concordant multimodality care was not delivered. Meaning These findings suggest that guideline-concordant multimodality care was associated with better prostate cancer–specific mortality outcomes for patients with high-risk prostate cancer. This cohort study assesses prostate cancer–specific mortality and distant metastasis outcomes among men with high-risk prostate cancer treated with radical prostatectomy or external beam radiotherapy with or without brachytherapy boost. Importance The optimal management strategy for high-risk prostate cancer and additional adverse clinicopathologic features remains unknown. Objective To compare clinical outcomes among patients with high-risk prostate cancer after definitive treatment. Design, Setting, and Participants This retrospective cohort study included patients with high-risk prostate cancer (as defined by the National Comprehensive Cancer Network [NCCN]) and at least 1 adverse clinicopathologic feature (defined as any primary Gleason pattern 5 on biopsy, clinical T3b-4 disease, ≥50% cores with biopsy results positive for prostate cancer, or NCCN ≥2 high-risk features) treated between 2000 and 2014 at 16 tertiary centers. Data were analyzed in November 2020. Exposures Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy (ADT), or EBRT plus brachytherapy boost (BT) with ADT. Guideline-concordant multimodal treatment was defined as RP with appropriate use of multimodal therapy (optimal RP), EBRT with at least 2 years of ADT (optimal EBRT), or EBRT with BT with at least 1 year ADT (optimal EBRT with BT). Main Outcomes and Measures The primary outcome was prostate cancer–specific mortality; distant metastasis was a secondary outcome. Differences were evaluated using inverse probability of treatment weight–adjusted Fine-Gray competing risk regression models. Results A total of 6004 men (median [interquartile range] age, 66.4 [60.9-71.8] years) with high-risk prostate cancer were analyzed, including 3175 patients (52.9%) who underwent RP, 1830 patients (30.5%) who underwent EBRT alone, and 999 patients (16.6%) who underwent EBRT with BT. Compared with RP, treatment with EBRT with BT (subdistribution hazard ratio [sHR] 0.78, [95% CI, 0.63-0.97]; P = .03) or with EBRT alone (sHR, 0.70 [95% CI, 0.53-0.92]; P = .01) was associated with significantly improved prostate cancer–specific mortality; there was no difference in prostate cancer–specific mortality between EBRT with BT and EBRT alone (sHR, 0.89 [95% CI, 0.67-1.18]; P = .43). No significant differences in prostate cancer–specific mortality were found across treatment cohorts among 2940 patients who received guideline-concordant multimodality treatment (eg, optimal EBRT alone vs optimal RP: sHR, 0.76 [95% CI, 0.52-1.09]; P = .14). However, treatment with EBRT alone or EBRT with BT was consistently associated with lower rates of distant metastasis compared with treatment with RP (eg, EBRT vs RP: sHR, 0.50 [95% CI, 0.44-0.58]; P |
| Databáze: | OpenAIRE |
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