Objectives

To compare the outcomes of radical prostatectomy (RP), intensity-modulated radiation therapy (IMRT), and low-dose-rate brachytherapy (BT) using propensity score matching analysis in patients with clinically localized prostate cancer.

Methods

A group of 2273 patients with clinically localized prostate cancer between January 2004 and December 2015 at the Yokohama City University hospital were identified. The records of 1817 of these patients, who were followed up for a minimum of 2 years, were reviewed; 462 were treated with RP, 319 with IMRT, and 1036 with BT. The patients were categorized according to the National Comprehensive Cancer Network risk classification criteria, and biochemical outcomes and overall survival rates were examined. Biochemical failure for RP was defined as prostate-specific antigen (PSA) levels > 0.2 ng/ml, and for IMRT and BT as nadir PSA level + 2 ng/ml. Propensity scores were calculated using multivariable logistic regression based on covariates, including the patient's age, preoperative PSA, Gleason score, number of positive cores, and clinical T stage.

Results

Median follow-up was 77 months for the RP, 54 months for IMRT, and 66 months for BT patients. After the propensity scores were adjusted, a total of 372 (186 each) and 598 (299 each) patients were categorized into RP vs IMRT and RP vs BT groups, respectively. Kaplan–Meier analysis did not show any statistically significant differences in terms of overall survival rate between these groups (RP vs IMRT: p = 0.220; RP vs BT: p = 0.429). IMRT was associated with improved biochemical failure-free survival compared to RP in all risk groups (high-risk: p < 0.001; intermediate-risk: p = 0.009; low-risk: p = 0.001), whereas significant differences were observed only in the intermediate-risk group (p = 0.003) within the RP vs BT group.

Conclusion

The results of our propensity score analysis of mid-term localized prostate cancer treatment outcomes demonstrated no significant differences in the overall survival rate. Despite the difference in biochemical failure definition between surgery and radiotherapeutic approaches, the results of this study demonstrate improved biochemical control favoring IMRT and BT as compared to RP.

中文翻译：

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单一机构中局限性前列腺癌的治疗效果：通过倾向评分匹配分析比较前列腺癌根治术和放射治疗的效果。

目标

为了比较在临床局限性前列腺癌患者中使用倾向评分匹配分析进行的前列腺癌根治术（RP），强度调节放射治疗（IMRT）和低剂量率近距离放射治疗（BT）的结果。

方法

在横滨市立大学医院，确定了2004年1月至2015年12月之间的2273例临床局限性前列腺癌患者。回顾了这些患者的1817例记录，随访了至少2年。462例接受RP治疗，319例接受IMRT治疗，1036例接受BT治疗。根据国家综合癌症网络风险分类标准对患者进行分类，并检查生化结果和总生存率。RP的生化衰竭定义为前列腺特异性抗原（PSA）水平> 0.2 ng / ml，IMRT和BT定义为最低PSA水平+ 2 ng / ml。使用多变量logistic回归根据协变量计算倾向得分，这些变量包括患者的年龄，术前PSA，格里森得分，阳性核心数，

结果

RP的中位随访时间为77个月，IMRT的中位随访时间为54个月，BT患者的中位随访时间为66个月。调整倾向得分后，分别将372（分别为186）和598（分别为299）的患者分为RP vs IMRT组和RP vs BT组。这些组之间的总生存率在Kaplan–Meier分析中没有发现任何统计学上的显着差异（RP与IMRT：p  = 0.220； RP与BT：p  = 0.429）。在所有风险组中，IMRT与RP相比均具有改善的生化无故障存活率（高风险：p  <0.001；中风险：p  = 0.009；低风险：p  = 0.001），而仅在中度风险组（p =相对于BT组为0.003）。

结论

我们对中期局部前列腺癌治疗结局的倾向评分分析结果表明，总生存率无显着差异。尽管手术和放射治疗方法在生化衰竭定义上存在差异，但本研究结果表明，与RP相比，改善的生化控制有利于IMRT和BT。