放射治疗与基于手术的治疗策略在高风险的前列腺癌中
Soumyajit Roy1, Yilun Sun2, James A Eastham3
1Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA; Department of Radiation Oncology, University Hospitals - Seidman Cancer Center, Cleveland, OH, USA.
European urology oncology
|July 19, 2025
概括
对于高风险的前列腺癌,基于放射治疗的治疗与激进前列腺切除术相比,显著减少了远程转移. 在两种治疗策略之间,转移后的死亡风险与治疗策略相似.
科学领域:
- 在瘤学瘤学.
- 辐射瘤学 辐射瘤学
- 尿道瘤学 尿道瘤学
背景情况:
- 对于高风险前列腺癌的最佳管理仍然不清楚.
- 利用来自两个北美合作组第三阶段随机对照试验 (RCT) 的个人患者数据.
- 基于放射治疗与基于激进前列腺切除术 (RP) 的治疗策略对高风险前列腺癌患者的比较.
研究的目的:
- 为了比较高风险前列腺癌患者的治疗结果,使用基于放射治疗和基于RP的策略.
- 评估远程转移的累积发病率作为主要终点.
- 使用治疗权重的逆概率 (IPTW) 将死亡视为一个竞争事件.
主要方法:
- 分析了NRG/RTOG 0521 (放射治疗) 和CALGB 90203 (手术) 试验的数据.
- 患者接受了放射治疗加上安卓素剥夺疗法 (ADT) ±dcetaxel,或RP与术后治疗±新辅助剂dcetaxel和ADT.
- 使用IPTW来比较远程转移的累积发病率.
主要成果:
- 包括1290名患者,随访时间相似.
- 接受手术的患者通常具有更有利的预后特征,并且年轻.
- 在IPTW之后,基于放射治疗的治疗显示出远程转移的8年累积发病率明显较低 (15%对22%;调整后的sHR为0.58;p=0.001).
结论:
- 与基于RP的治疗相比,基于放射治疗的治疗显著降低了高风险前列腺癌患者远程转移的发生率.
- 远程转移后死亡风险在放射治疗和RP组之间是可比的.
- 这些发现表明,基于放射治疗的策略可能为高风险的前列腺癌提供更好的远程控制.
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