Francesco Di Bello, Lukas Scheipner, Andrea Baudo, Mario de Angelis, Letizia Maria Ippolita Jannello, Carolin Siech, Zhe Tian, Kira Vitucci, Jordan A Goyal, Claudia Collà Ruvolo, Gianluigi Califano, Massimiliano Creta, Simone Morra, Pietro Acquati, Fred Saad, Shahrokh F Shariat, Luca Carmignani, Ottavio de Cobelli, Sascha Ahyai, Alberto Briganti, Felix K H Chun, Nicola Longo, Pierre I Karakiewicz
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Cumulative incidence plots as well as competing risks regression (CRR) models were fitted to address CSM after adjustment for other-cause mortality (OCM). Furthermore, a subgroup analysis was performed to test for CSM differences between RP and RT according to Gleason sum (GS 6,7, and 8-10).</p><p><strong>Results: </strong>Of 1,466 IPCa patients, 770 (53%) underwent RP vs. 696 (47%) RT. Incidental PCa RT patients were older, and exhibited higher PSA, higher proportion of Gleason sum 8-10, and higher clinical T stage. In cumulative incidence plots, 5-year CSM rates adjusted for OCM were 0.9 for RP vs. 6.8% for RT (Δ = 5.9%). After multivariable adjustment for clinical characteristics (age, PSA, Gleason sum, and clinical T stage) as well as for OCM, RP was associated with a protective hazard ratio (HR) of 0.35 (95% confidence interval [CI] 0.15 - 0.78, p value = .01). Within Gleason sum 8-10 IPCA patients, RP was associated with a protective HR of 0.31 (P = .039).</p><p><strong>Conclusion: </strong>Incidental PCa RT-treated patients exhibited less favorable clinical characteristics than their RP counterparts. Despite full adjustment, RP was associated with a protective effect relative to RT. This effect exclusively applied to the Gleason sum 8-10 subgroup. 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引用次数: 0
摘要
目的：检测偶发性前列腺癌（IPCa）患者根治性前列腺切除术（RP）或放疗（RT）后癌症特异性死亡率（CSM）的差异。患者和方法：在监测、流行病学和最终结果（SEER）数据库（2004-2015）中，确定了IPCa患者。在调整其他原因死亡率（OCM）后，拟合累积发生率图和竞争风险回归（CRR）模型来解决CSM问题。此外，根据Gleason和（GS 6,7和8-10）进行亚组分析，以检验RP和RT之间的CSM差异。结果：在1466例IPCa患者中，770例（53%）接受了RP， 696例（47%）接受了RT。偶发性PCa RT患者年龄较大，PSA较高，Gleason sum 8-10比例较高，临床T分期较高。在累积发病率图中，经OCM调整后的5年CSM率，RP为0.9，RT为6.8% （Δ = 5.9%）。在对临床特征（年龄、PSA、Gleason和临床T分期）以及OCM进行多变量调整后，RP与保护性风险比（HR）相关为0.35（95%可信区间[CI] 0.15 - 0.78， p值 = 0.01）。在Gleason sum 8-10例IPCA患者中，RP与保护性HR相关为0.31 （P = .039）。结论：偶发PCa rt治疗患者的临床特征较RP治疗患者差。尽管完全调整，RP相对于rt具有保护作用。这种作用仅适用于Gleason sum 8-10亚组。因此，患有Gleason sum 8-10的IPCa患者应理想地考虑RP而不是RT。
Cancer-specific mortality after radical prostatectomy versus radiotherapy in incidental prostate cancer.
Introduction: To test for cancer specific mortality (CSM) differences after either radical prostatectomy (RP) or radiotherapy (RT) in incidental prostate cancer (IPCa) patients.
Patients and methods: Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015), IPCa patients were identified. Cumulative incidence plots as well as competing risks regression (CRR) models were fitted to address CSM after adjustment for other-cause mortality (OCM). Furthermore, a subgroup analysis was performed to test for CSM differences between RP and RT according to Gleason sum (GS 6,7, and 8-10).
Results: Of 1,466 IPCa patients, 770 (53%) underwent RP vs. 696 (47%) RT. Incidental PCa RT patients were older, and exhibited higher PSA, higher proportion of Gleason sum 8-10, and higher clinical T stage. In cumulative incidence plots, 5-year CSM rates adjusted for OCM were 0.9 for RP vs. 6.8% for RT (Δ = 5.9%). After multivariable adjustment for clinical characteristics (age, PSA, Gleason sum, and clinical T stage) as well as for OCM, RP was associated with a protective hazard ratio (HR) of 0.35 (95% confidence interval [CI] 0.15 - 0.78, p value = .01). Within Gleason sum 8-10 IPCA patients, RP was associated with a protective HR of 0.31 (P = .039).
Conclusion: Incidental PCa RT-treated patients exhibited less favorable clinical characteristics than their RP counterparts. Despite full adjustment, RP was associated with a protective effect relative to RT. This effect exclusively applied to the Gleason sum 8-10 subgroup. In consequence, IPCa patients harboring Gleason sum 8-10 should ideally be considered for RP instead of RT.
期刊介绍：
Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.
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