放疗后局部前列腺癌患者按风险分类的实际疗效差异

The Prostate Pub Date : 2024-04-30 DOI:10.1002/pros.24720
Lawrence Karsh, Shawn Du, Jinghua He, Dexter Waters, Erik Muser, Neal Shore
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Baseline patient characteristics were summarized, metastasis‐free survival (MFS), overall survival, and time to initiation of advanced prostate cancer treatment were compared using Kaplan−Meier (KM) and adjusted Cox proportional hazard (PH) models. 5‐year survival probabilities stratified by race/ethnicity (non‐Hispanic [NH] White, NH Black, NH Asian, and Hispanic) were assessed.ResultsOf 11,313 eligible patients, 41% (<jats:italic>n</jats:italic> = 4600) had HR‐LPC and 59% (<jats:italic>n</jats:italic> = 6713) had LIR‐LPC. Patient characteristics for both groups were comparable, with mean age at EBRT initiation &gt; 70 years, 86% white, and mean follow‐up time &gt;40 months. More patients in the HR‐LPC than LIR‐LPC groups (78% vs 34%) had concurrent androgen deprivation therapy use and for a longer duration (median 10.4 months vs. 7.4 months). A higher proportion of HR‐LPC patients developed metastasis, died, or received advanced prostate cancer treatment. 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引用次数: 0

摘要

背景关于接受体外放射治疗(EBRT)作为初始治疗的局部前列腺癌(LPC)患者的长期临床疗效的实际证据有限。这项研究评估了接受EBRT治疗的美国高危LPC(HR-LPC)和低/中危LPC(LIR-LPC)患者的临床疗效。方法这项回顾性研究使用了2012年至2019年的监测、流行病学和最终结果--医保链接数据,纳入了年龄≥65岁、接受EBRT作为初始治疗的患者。研究人员总结了患者的基线特征,并使用卡普兰-梅耶(KM)模型和调整后的考克斯比例危险(PH)模型比较了无转移生存期(MFS)、总生存期和开始晚期前列腺癌治疗的时间。结果 在11313名符合条件的患者中,41%(n = 4600)患有HR-LPC,59%(n = 6713)患有LIR-LPC。两组患者的特征相当,开始接受 EBRT 治疗时的平均年龄为 70 岁,86% 为白人,平均随访时间为 40 个月。与LIR-LPC组相比,HR-LPC组中有更多的患者(78%对34%)同时使用雄激素剥夺疗法,而且持续时间更长(中位10.4个月对7.4个月)。HR-LPC患者出现转移、死亡或接受晚期前列腺癌治疗的比例较高。调整后的 Cox PH 生存分析显示,HR-LPC 患者的死亡风险(危险比 [HR],1.57 [1.38,2.34])、转移或死亡风险(HR,1.97 [1.78,2.17])以及接受晚期前列腺癌治疗的风险(HR,2.57 [2.11,3.14])均显著高于 LIR-LPC 患者(p < 0.0001)。在首次接受 EBRT 治疗后的 5 年内,预计有 18%-26% 的 HR-LPC 患者死亡或发生转移。在所有种族/族裔亚群中,HR-LPC 组的 5 年 MFS 率均低于 LIR-LPC 组。与其他种族/族裔亚群相比,NH 黑人 HR-LPC 患者的全因死亡率最高,接受晚期前列腺癌治疗的比例最低。结论这项对接受 EBRT 治疗的 LPC 患者的临床预后进行的真实世界研究表明,HR-LPC 患者的疾病负担很重,并强调需要更多的治疗策略来改善 HR-LPC 患者的临床预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Differences in real‐world outcomes by risk classification for localized prostate cancer patients after radiation therapy
BackgroundLimited real‐world evidence exists on the long‐term clinical outcomes of patients with localized prostate cancer (LPC) who received external beam radiation therapy (EBRT) as the initial treatment. This study evaluated clinical outcomes of US patients with high‐risk LPC (HR‐LPC) and low/intermediate‐risk LPC (LIR‐LPC) who received EBRT.MethodsThis retrospective study using Surveillance, Epidemiology, and End Results‐Medicare linked data from 2012 to 2019 included patients ≥ 65 years old who received EBRT as initial therapy. Baseline patient characteristics were summarized, metastasis‐free survival (MFS), overall survival, and time to initiation of advanced prostate cancer treatment were compared using Kaplan−Meier (KM) and adjusted Cox proportional hazard (PH) models. 5‐year survival probabilities stratified by race/ethnicity (non‐Hispanic [NH] White, NH Black, NH Asian, and Hispanic) were assessed.ResultsOf 11,313 eligible patients, 41% (n = 4600) had HR‐LPC and 59% (n = 6713) had LIR‐LPC. Patient characteristics for both groups were comparable, with mean age at EBRT initiation > 70 years, 86% white, and mean follow‐up time >40 months. More patients in the HR‐LPC than LIR‐LPC groups (78% vs 34%) had concurrent androgen deprivation therapy use and for a longer duration (median 10.4 months vs. 7.4 months). A higher proportion of HR‐LPC patients developed metastasis, died, or received advanced prostate cancer treatment. Adjusted Cox PH survival analyses showed significantly (p < 0.0001) higher risk of mortality (hazard ratios [HR], 1.57 [1.38, 2.34]), metastasis or death (HR, 1.97 [1.78, 2.17]), and advanced prostate cancer therapy use (HR, 2.57 [2.11, 3.14]) for HR‐LPC than LIR‐LPC patients. Within 5 years after the initial EBRT treatment, 18%−26% of patients with HR‐LPC are expected to have died or developed metastasis. The 5‐year MFS rate in the HR‐LPC group was lower than the LIR‐LPC group across all racial/ethnic subgroups. NH Black patients with HR‐LPC had the highest all‐cause mortality rate and lowest rate of receiving advanced prostate cancer treatment, compared to other racial/ethnic subgroups.ConclusionsThis real‐world study of clinical outcomes in patients with LPC treated with EBRT suggests substantial disease burden in patients with HR‐LPC and highlights the need for additional treatment strategies to improve clinical outcomes in patients with HR‐LPC.
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