限局性前立腺がんに対する凍結療法、レーザー焼灼療法、温熱療法の腫瘍学的予後の比較：SEERデータベースを用いた集団ベースコホート研究

Ablative therapies, including cryoablation (CA), laser ablation (LA), and hyperthermia (HT), are increasingly used for localized prostate cancer, but large-scale comparative evidence on their long-term oncologic outcomes is scarce. This study aimed to compare cancer-specific survival (CSS) and overall survival (OS) among patients treated with these modalities.

Using the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019), we identified patients with localized prostate cancer treated with CA, LA, or HT between 2010 and 2019. Propensity score matching (PSM) at a 1:1 ratio was performed to balance baseline characteristics. OS and CSS were estimated using the Kaplan-Meier method, and competing risk analysis was performed to assess cancer-specific mortality (CSM) and other-cause mortality (OCM).

After PSM, 712 patients per group were compared between CA and LA. No significant difference was observed in CSS (Hazard Ratio [HR] = 1.58, 95% Confidence Interval [CI] 0.94-2.66; P = .083) or OS (HR = 1.09, 95% CI, 0.88-1.35; P = .481). The median follow-up was 64 months, with 18 and 23 cancer-specific deaths in the CA and LA groups, respectively. In comparisons involving HT (n = 107 per group post-PSM), no statistically significant differences in survival were detected against CA or LA. However, these HT-related findings must be interpreted with extreme caution due to the significant heterogeneity of the HT category, the small sample size, and resulting low statistical power.

In this large population-based study, CA and LA demonstrated comparable long-term oncologic outcomes for localized prostate cancer. While no survival differences were detected for HT, definitive conclusions cannot be drawn for this modality due to major methodological limitations. Further prospective, well-designed randomized controlled trials are essential to validate these findings and provide more robust evidence.