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Survival Outcomes of Men with Lymph Node-positive Prostate Cancer After Radical Prostatectomy: A Comparative Analysis of Different Postoperative Management Strategies
European Urology ( IF 23.4 ) Pub Date : 2017-10-16 , DOI: 10.1016/j.eururo.2017.09.027
Karim A. Touijer , Robert Jeffery Karnes , Niccolo Passoni , Daniel D. Sjoberg , Melissa Assel , Nicola Fossati , Giorgio Gandaglia , James A. Eastham , Peter T. Scardino , Andrew Vickers , Cesare Cozzarini , Francesco Montorsi , Alberto Briganti

Background

Optimal management of patients with lymph node metastasis (LNM) after radical prostatectomy (RP) remains undefined.

Objective

We evaluated the association between three different management strategies and survival in prostate cancer with LNM after RP.

Design, setting, and participants

We analyzed data of 1338 patients with LNM after RP from three tertiary care centers. Three hundred and eighty-seven patients (28%) were observed, 676 (49%) received lifelong adjuvant androgen deprivation therapy (ADT), and 325 (23%) received adjuvant external beam radiation therapy (EBRT) and ADT. Three hundred and sixty-eight men were followed for more than 10 yr.

Outcome measurements and statistical analysis

Primary outcome measure was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS) and other-cause mortality. Kaplan-Meier methods were used to visualize OS for the three treatment groups. Cox proportional hazards regression was utilized to compare OS and CSS among the three groups.

Results and limitations

ADT + EBRT was associated with better OS than ADT alone (hazard ratio [HR]: 0.46, 95% confidence interval [CI]: 0.32–0.66, p < 0.0001) or observation (HR: 0.41, 95% CI: 0.27–0.64, p < 0.0001). Higher-risk patients benefited more from ADT + EBRT than lower-risk patients. Ten-year mortality risk difference between ADT + EBRT, observation, or ADT alone ranged from 5% in low-risk patients to 40% in high-risk patients. Adjuvant ADT + EBRT was also associated with better CSS than observation or ADT alone (p < 0.0001), ADT had better CSS compared to observation (HR: 0.64, 95% CI: 0.43–0.95, p = 0.027). However, ADT was associated with an increased risk of other-cause mortality (HR: 3.05, 95% CI: 1.45–6.40, p = 0.003) compared with observation, resulting in similar OS between ADT and observation (HR: 0.90, 95% CI: 0.65–1.25, p = 0.5). While selection bias might remain, its effect would operate in the opposite direction to our findings.

Conclusions

In men with LNM after RP, ADT + EBRT improved survival over either observation or adjuvant ADT alone. This survival benefit increases with higher-risk disease.

Patient summary

Lymph node metastasis following radical prostatectomy is associated with poor survival outcomes. However, we found that adjuvant androgen deprivation therapy with external beam radiation therapy improved survival in these patients.



中文翻译:

前列腺癌根治术后男性淋巴结阳性前列腺癌患者的生存结局:不同术后管理策略的比较分析

背景

根治性前列腺切除术(RP)后淋巴结转移(LNM)患者的最佳管理仍不确定。

客观的

我们评估了RP后LNM的三种不同管理策略与前列腺癌生存率之间的关联。

设计,设置和参与者

我们分析了来自三个三级护理中心的RP后1338例LNM患者的数据。观察到387例患者(28%),676例(49%)接受终生辅助性雄激素剥夺治疗(ADT),325例(23%)接受辅助外束放射治疗(EBRT)和ADT。追踪了368名男子10年以上。

成果测量和统计分析

主要结局指标是总生存期(OS)。次要结果是癌症特异性生存率(CSS)和其他原因的死亡率。Kaplan-Meier方法用于可视化三个治疗组的OS。使用Cox比例风险回归比较三组之间的OS和CSS。

结果与局限性

与单独使用ADT相比,ADT + EBRT的OS更好(危险比[HR]:0.46,95%置信区间[CI]:0.32-0.66,p  <0.0001)或观察(HR:0.41,95%CI:0.27-0.64) ,p  <0.0001)。与低风险患者相比,高风险患者从ADT + EBRT中受益更多。仅ADT + EBRT,观察值或ADT的十年死亡率风险差异范围从低危患者的5%到高危患者的40%。辅助ADT + EBRT的CSS比观察值或单独使用 ADT更好(p <0.0001),与观察相比,ADT的CSS更好(HR:0.64,95%CI:0.43-0.95,p  = 0.027)。但是,ADT与其他原因致死的风险增加相关(HR:3.05,95%CI:1.45-6.40,p = 0.003)与观察值相比,ADT和观察值之间的OS相似(HR:0.90,95%CI:0.65-1.25,p  = 0.5)。尽管选择偏见可能仍然存在,但其影响将与我们的发现相反。

结论

在RP后LNM的男性中,ADT + EBRT比单纯观察或辅助ADT可以提高生存率。高危疾病会增加这种生存优势。

病人总结

根治性前列腺切除术后淋巴结转移与生存不良有关。然而,我们发现辅助放射治疗和雄激素剥夺疗法可改善这些患者的生存率。

更新日期:2017-10-16
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