| 摘要: | Background: In the ever-changing clinical landscape, prostate cancer has been a primary health concern for decades. With the advent of population aging and the keen advancements in therapy procedures, few studies have evaluated optimal definitive treatment choice for men older than 80 years with High Risk Localized Prostate Cancer (HR-LPC). Guidelines have remained vague in this respect, leaving clinicians and patients with the heavy burden of choice without the necessary information, and health systems with the weight of the implications.
Objective: This study aims to compare survival outcomes of patients >80 years old with HR-LPC after they underwent either Radical Prostatectomy (RP) or massive-dose Intensity-Modulated Radiotherapy (IMRT) coupled with Androgen Deprivation therapy (ADT) over a long-term investigation.
Method: In this large-scale cross-country study, the Taiwan Cancer Registry Database (TCRD) was consulted to gather data concerning elderly patients aged 80 or older diagnosed with High Risk Localized Prostate Cancer (HR-LPC). These patients were divided into two cohorts: the control group, consisting of those who underwent standard (Radical Prostatectomy) RP, and the case group, consisting of those who received a high dose of IMRT (at least 72 Gy) along with long-term (minimum of 18 months) ADT. To account for potential influencing factors, propensity score matching (PSM) was employed to ensure comparability between the two groups. Subsequently, Cox proportional hazards regression was used to assess the cancer prognosis in both groups.
Results: A total of 3,370 cases patients older than 80 years of age with prostate cancer tissue stages T1 to T2C, and no distant metastasis, were initially included in this study. After this, seven exclusion criteria were applied. The remaining sample size of patients after all the exclusion criteria was 2,131 cases (1,832 RP; 291 IMRT + ADT). The IMRT + ADT group had a significantly higher adjusted hazard ratio (aHR) for all-cause mortality (aHR, 2.00; 95% confidence interval [CI], 1.41–2.87) than the RP group. Analysis of the secondary outcomes revealed that compared with the RP group, the aHRs of biochemical failure, locoregional recurrence, and distant metastasis in the IMRT + ADT group were 1.77 (95% CI: 1.36–2.11, p < 0.0001), 1.12 (95% CI: 1.04–1.33, p < 0.0001), and 1.15 (95% CI: 1.06–1.71, p = 0.0311), respectively.
Conclusion: RP provides more favorable oncological prognostication than IMRT in very old adults with HR-LPC. |
