PDF(Sci-hub)
Abstract：
There are few comparative outcomes data regarding the therapeutic delivery of proton beam therapy (PBT) versus the more widely used photon-based external-beam radiation (EBRT) and brachytherapy (BT). We evaluated the impact of PBT on overall survival (OS) compared to EBRT or BT on patients with localized prostate cancer.
The National Cancer Data Base (NCDB) was queried for 2004-2015. Men with clinical stage T1-3, N0, M0 prostate cancer treated with radiation, without surgery or chemotherapy, were included. OS, the primary clinical outcome, was fit by Cox proportional hazard model. Propensity score matching was implemented for covariate balance.
There were 276,880 eligible patients with a median follow-up of 80.9 months. A total of 4900 (1.8%) received PBT, while 158,111 (57.1%) received EBRT and 113,869 (41.1%) BT. Compared to EBRT and BT, PBT patients were younger and were less likely to be in the high-risk group. On multivariable analysis, compared to PBT, men had worse OS after EBRT (adjusted hazard ratio [HR] = 1.72; 95% confidence interval [CI], 1.51-1.96) or BT (adjusted HR = 1.38; 95% CI, 1.21-1.58). After propensity score matching, the OS benefit of PBT remained significant compared to EBRT (HR = 1.64; 95% CI, 1.32-2.04) but not BT (adjusted HR = 1.18; 95% CI, 0.93-1.48). The improvement in OS with PBT was most prominent in men ≤ 65 years old with low-risk disease compared to other subgroups (interaction P < .001).
In this national data set, PBT was associated with a significant OS benefit compared to EBRT, and with outcomes similar to BT. These results remain to be validated by ongoing prospective trials.
The National Cancer Data Base (NCDB) was queried for 2004-2015. Men with clinical stage T1-3, N0, M0 prostate cancer treated with radiation, without surgery or chemotherapy, were included. OS, the primary clinical outcome, was fit by Cox proportional hazard model. Propensity score matching was implemented for covariate balance.
There were 276,880 eligible patients with a median follow-up of 80.9 months. A total of 4900 (1.8%) received PBT, while 158,111 (57.1%) received EBRT and 113,869 (41.1%) BT. Compared to EBRT and BT, PBT patients were younger and were less likely to be in the high-risk group. On multivariable analysis, compared to PBT, men had worse OS after EBRT (adjusted hazard ratio [HR] = 1.72; 95% confidence interval [CI], 1.51-1.96) or BT (adjusted HR = 1.38; 95% CI, 1.21-1.58). After propensity score matching, the OS benefit of PBT remained significant compared to EBRT (HR = 1.64; 95% CI, 1.32-2.04) but not BT (adjusted HR = 1.18; 95% CI, 0.93-1.48). The improvement in OS with PBT was most prominent in men ≤ 65 years old with low-risk disease compared to other subgroups (interaction P < .001).
In this national data set, PBT was associated with a significant OS benefit compared to EBRT, and with outcomes similar to BT. These results remain to be validated by ongoing prospective trials.
摘要：
关于质子束治疗（PBT）与更广泛使用的基于光子的外部束辐射（EBRT）和近距离放射治疗（BT）的治疗递送，几乎没有比较结果的数据。与EBRT或BT相比，我们评估了PBT对局部前列腺癌患者总生存期（OS）的影响。
查询了2004-2015年的国家癌症数据库（NCDB）。临床分期为T1-3、N0、M0的前列腺癌患者接受放射治疗，没有手术或化疗，包括在内。操作系统,主要临床结果，通过Cox比例风险模型拟合。对于协变量平衡实施倾向得分匹配。
有276,880名合格患者，中位随访时间为80.9个月。共有4900人(1.8%)获得PBT,而158,111（57.1%）收到EBRT和113,869（41.1%）BT。与EBRT和BT相比，PBT患者年龄较小，在高危人群中的可能性较小。在多变量分析中，与PBT相比，男性在EBRT后OS更差(调整后的风险比[HR]=1.72；95%置信区间[CI]，1.51-1.96)或BT(调整后的HR=1.38；95%CI，1.21-1.58)。在倾向得分匹配后，与EBRT相比,PBT的OS获益仍然显著(HR=1.64;95%CI,1.32-2.04),但与BT无关(校正后HR=1.18;95%CI,0.93-1.48).与其他亚组相比，PBT组的OS改善在≤65岁的低危患者中最为显著（交互作用P<.001）。
在这个国家数据集中，与EBRT相比，PBT与显著的OS优势相关，结果与BT相似。这些结果仍有待正在进行的前瞻性试验验证。
查询了2004-2015年的国家癌症数据库（NCDB）。临床分期为T1-3、N0、M0的前列腺癌患者接受放射治疗，没有手术或化疗，包括在内。操作系统,主要临床结果，通过Cox比例风险模型拟合。对于协变量平衡实施倾向得分匹配。
有276,880名合格患者，中位随访时间为80.9个月。共有4900人(1.8%)获得PBT,而158,111（57.1%）收到EBRT和113,869（41.1%）BT。与EBRT和BT相比，PBT患者年龄较小，在高危人群中的可能性较小。在多变量分析中，与PBT相比，男性在EBRT后OS更差(调整后的风险比[HR]=1.72；95%置信区间[CI]，1.51-1.96)或BT(调整后的HR=1.38；95%CI，1.21-1.58)。在倾向得分匹配后，与EBRT相比,PBT的OS获益仍然显著(HR=1.64;95%CI,1.32-2.04),但与BT无关(校正后HR=1.18;95%CI,0.93-1.48).与其他亚组相比，PBT组的OS改善在≤65岁的低危患者中最为显著（交互作用P<.001）。
在这个国家数据集中，与EBRT相比，PBT与显著的OS优势相关，结果与BT相似。这些结果仍有待正在进行的前瞻性试验验证。
