Comparison of salvage radical prostatectomy vs. salvage ablation therapy for biopsy-proven radio-recurrent localized prostate cancer.

IF 1.9 4区 医学 Q3 UROLOGY & NEPHROLOGY
Victor McPherson, Shiva M Nair, Amy L Tin, Malcolm Dewar, Khurram Siddiqui, Daniel D Sjoberg, Andrew J Vickers, James Eastham, Joseph L Chin
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引用次数: 0

Abstract

Introduction: Radiation therapy for prostate cancer is associated with a 15-20% five-year recurrence rate. Patients with recurrence in the prostate only are candidates for salvage local therapies; however, there is no consensus on modality. This study uses registries at Memorial Sloan Kettering Cancer Center (MSKCC) and University of Western Ontario (UWO) to compare the oncologic outcomes of salvage radical prostatectomy (SRP) and salvage ablation (SA).

Methods: A total of 444 patients were available for analysis. Due to intergroup differences, propensity score methodology was used and identified 378 patients with more comparable pre-salvage prostate-specific antigen (PSA), Gleason score, and primary radiation treatment. Patients underwent SRP at MSKCC and SA at UWO.

Results: Of the 378 patients, 48 died of disease, with a 6.0-year median (interquartile range [IQR] 3.0, 9.7) followup among survivors; 88 developed metastases, with a median 4.6-year (IQR 2.3, 7.9) followup among metastasis-free survivors. There was a non-significantly higher rate of cancer-specific (hazard ratio [HR ] 1.02, 95% confidence interval [CI] 0.51, 2.06, p=0.9) and improved metastasis-free survival (HR 0.71, 95% CI 0.44, 1.13, p=0.15) among patients undergoing SA compared to patients undergoing SRP. There were 143 patients who received hormonal therapy, with higher rates of androgen deprivation therapy (ADT) in SA (HR 1.42, 95% CI 0.97, 2.08, p=0.068), although this did not meet conventional levels of significance.

Conclusions: This propensity score analysis of salvage therapy for radio-recurrent prostate cancer identified no statistically significant differences in oncologic outcome between SRP and SA; however, there was evidence of a lower risk of ADT in the cohort undergoing SRP. Given they are both potentially curative therapies, these treatments are viable options for men with clinically localized, radio-recurrent prostate cancer rather than ADT alone. Future research may further elucidate subpopulations that may be more amenable to either SRP or SA.

挽救性根治性前列腺切除术与挽救性消融术治疗生物梅毒放射性局限性前列腺癌症的比较。
简介:癌症的放射治疗与15-20%的五年复发率相关。前列腺复发的患者只是挽救性局部治疗的候选者,然而,在治疗方式上还没有达成共识。本研究使用纪念斯隆-凯特琳癌症中心(MSKCC)和西安大略大学(UWO)的注册资料,比较挽救性前列腺切除术(SRP)和挽救性消融术(SA)的肿瘤学结果。方法:共有444名患者可供分析。由于组间差异,使用倾向评分方法,确定378名患者具有更具可比性的lvage前PSA、Gleason评分和初级放射治疗。患者在MSKCC接受SRP,在UWO接受SA。结果:378名患者中,48人死于疾病,幸存者的中位随访时间为6.0年(四分位间距[IQR]3.0,9.7);88例发生转移,无转移幸存者中位随访4.6年(IQR2.3,7.9)。与接受SRP的患者相比,接受SA的患者的癌症特异性(危险比[HR]1.02,95%置信区间[CI]0.51,2.06,p=0.9)和无转移生存率改善(HR 0.71,95%CI 0.44,1.13,p=0.15)的发生率不显著更高。共有143名患者接受了激素治疗,SA中雄激素剥夺治疗(ADT)的发生率较高(HR 1.42,95%CI 0.97,2.08,p=0.068),尽管这不符合常规意义水平。结论:对放射性前列腺癌症挽救治疗的倾向评分分析表明,SRP和SA之间的肿瘤结果没有统计学上的显著差异;然而,有证据表明,在接受SRP的队列中,ADT的风险较低。鉴于它们都是潜在的治疗方法,这些治疗方法对于患有临床局限性放射性前列腺癌症的男性来说是可行的选择,而不是单独的ADT。未来的研究可能会进一步阐明可能更适合SRP或SA的亚群。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Cuaj-Canadian Urological Association Journal
Cuaj-Canadian Urological Association Journal 医学-泌尿学与肾脏学
CiteScore
2.80
自引率
10.50%
发文量
167
审稿时长
>12 weeks
期刊介绍: CUAJ is a a peer-reviewed, open-access journal devoted to promoting the highest standard of urological patient care through the publication of timely, relevant, evidence-based research and advocacy information.
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