Radiation Therapy After Radical Prostatectomy: Impact on Metastasis and Survival

医学 前列腺切除术 放射治疗 危险系数 比例危险模型 内科学 挽救疗法 生化复发 泌尿科 肿瘤科 前列腺癌 队列 佐剂 外科 转移 癌症 化疗 置信区间
作者
Stephen A. Boorjian,R. Jeffrey Karnes,Paul L. Crispen,Laureano J. Rangel,Eric J. Bergstralh,Michael L. Blute
出处
期刊:The Journal of Urology [Ovid Technologies (Wolters Kluwer)]
卷期号:182 (6): 2708-2715 被引量:98
标识
DOI:10.1016/j.juro.2009.08.027
摘要

Although secondary radiation therapy decreases the risk of biochemical progression after radical prostatectomy, its impact on metastasis and survival is less well established. We evaluated the impact of adjuvant and salvage radiotherapy on clinical progression and mortality.A total of 361 patients who received adjuvant radiation were matched based on clinicopathological features to patients who did not receive adjuvant radiation in a 2:1 case-control ratio. Postoperative survival was estimated using the Kaplan-Meier method and compared using the log rank test. A second cohort of 2,657 men who experienced biochemical recurrence after prostatectomy was separately evaluated. Cox proportional hazard regression models were used to analyze the impact of salvage radiotherapy on disease progression and survival.Adjuvant radiotherapy was associated with significantly improved 10-year biochemical recurrence-free survival (63% vs 45%, p <0.001), local recurrence-free survival (97% vs 82%, p <0.001) and a decreased need for late hormone therapy (17% vs 28%, p = 0.002) but did not impact systemic progression and overall survival (p = 0.94 and 0.27, respectively). Of the 2,657 patients who experienced biochemical recurrence after surgery 856 (32.3%) received salvage radiation. On multivariate analysis salvage radiotherapy decreased the risk of local recurrence (HR 0.13, 95% CI 0.06-0.28, p <0.0001) and delayed hormonal therapy (HR 0.81, 95% CI 0.71-0.93, p = 0.003) and systemic progression (HR 0.24, 95% CI 0.13-0.45, p <0.0001) but did not significantly impact mortality (p = 0.48).Adjuvant and salvage radiation provide long-term local control and decrease the need for delayed hormonal therapy but neither improves survival. These results must be weighed against the potential morbidity of postoperative radiation when counseling patients.
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