PDF(Pubmed)
Abstract：
Background: Lymph-nodal prostate cancer oligometastases are differently treated according to their site: pelvic are locoregional lymph nodes; instead, para-aortic lymph nodes are considered as distant metastases. The aim of the study was a comparison between para-aortic and pelvic oligometastases treated with stereotactic body radiation therapy (SBRT). Methods: This is a retrospective analysis. De novo metastatic or extra-nodal disease were excluded. Univariate and multivariate analyses were performed; the pattern of recurrence was also evaluated. A propensity score matching (PSM) was applied to create comparable cohorts. The primary end-point was the progression-free survival (PFS). The secondary end-points were biochemical relapse-free survival (BRFS), ADT-free survival (ADTFS), polymetastases-free survival (PMFS), local progression-free survival (LPFS), and pattern of relapse. Results: In total, 240 lymph-nodal oligometastases in 164 patients (127 pelvic and 37 para-aortic) were treated. The median PFS was 20 and 11 months in pelvic and para-aortic patients, respectively (p = 0.042). The difference was not confirmed in the multivariate analysis (p = 0.06). The median BRFS was 16 and 9 months, respectively, in the pelvic and para-aortic group (p = 0.07). No statistically significant differences for ADTFS or PMFS were detected. The cumulative 5-year LPFS was 90.5%. In PSM, no statistically significant differences for all the study end-points were detected. Conclusions: Patients affected by para-aortic disease might have a PFS comparable to pelvic disease; local control is high in both cohorts. Our results also support the use of SBRT for para-aortic metastases.
摘要：
背景：淋巴结前列腺癌寡转移根据其部位有不同的治疗方法：盆腔是局部淋巴结；相反，主动脉旁淋巴结被认为是远处转移。该研究的目的是比较立体定向身体放射治疗（SBRT）治疗的主动脉旁和盆腔寡转移。方法：回顾性分析。从头转移或结外疾病被排除。进行了单变量和多变量分析；还评估了复发的模式。应用倾向评分匹配(PSM)来创建可比较的队列。主要终点是无进展生存期（PFS）。次要终点是生化无复发生存期（BRFS），无ADT生存（ADTFS），无多转移生存期（PMFS），局部无进展生存期（LPFS），和复发模式。结果：总的来说，对164例患者（127例盆腔和37例主动脉旁）的240例淋巴结寡转移进行了治疗。骨盆和主动脉旁患者的中位PFS为20和11个月，分别（p=0.042）。在多变量分析中没有证实差异(p=0.06)。BRFS中位数为16个月和9个月，分别,在骨盆和主动脉旁组中（p=0.07）。未检测到ADTFS或PMFS的统计学差异。5年累计LPFS为90.5%。在PSM中,所有研究终点均未检测到统计学显著差异.结论：受主动脉旁疾病影响的患者的PFS可能与盆腔疾病相当；两个队列的局部控制率都很高。我们的结果也支持SBRT用于主动脉旁转移。
