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Abstract：
BACKGROUND: The optimal treatment approach for low-risk prostate cancer (LRPC) remains controversial. While active surveillance is an increasingly popular option, definitive local treatments, including radical prostatectomy (RP), external beam radiotherapy (EBRT), and prostate seed implantation (PSI), are also commonly used. This study aimed to evaluate the survival outcomes of patients with LRPC using a large patient population from the National Cancer Database (NCDB).
METHODS: We analyzed data from 195,452 patients diagnosed with LRPC between 2004 and 2015 using the NCDB. Patients were classified based on their treatment modalities, including RP, EBRT, PSI, or no local treatment (NLT). Only patients with Charlson-Deyo comorbidity scores of 0 or 1 were included to ensure comparability. Propensity score analysis was used to balance the treatment groups, and the accelerated failure time model was used to analyze the survival rates of the treatment groups.
RESULTS: After a median follow-up of 70.8 months, 24,545 deaths occurred, resulting in an all-cause mortality rate of 13%. RP demonstrated a survival benefit compared with NLT, particularly in patients younger than 74 years of age. In contrast, radiation treatments (EBRT and PSI) did not improve survival in the younger age groups, except for patients older than 70 years for EBRT and older than 65 years for PSI. Notably, EBRT in patients younger than 65 years was associated with inferior outcomes.
CONCLUSIONS: This study highlights the differences in survival outcomes among LRPC treatment modalities. RP was associated with improved survival compared to NLT, especially in younger patients. In contrast, EBRT and PSI showed survival benefits primarily in the older age groups. NLT is a reasonable choice, particularly in younger patients when RP is not chosen. These findings emphasize the importance of individualized treatment decisions for LRPC management.
METHODS: We analyzed data from 195,452 patients diagnosed with LRPC between 2004 and 2015 using the NCDB. Patients were classified based on their treatment modalities, including RP, EBRT, PSI, or no local treatment (NLT). Only patients with Charlson-Deyo comorbidity scores of 0 or 1 were included to ensure comparability. Propensity score analysis was used to balance the treatment groups, and the accelerated failure time model was used to analyze the survival rates of the treatment groups.
RESULTS: After a median follow-up of 70.8 months, 24,545 deaths occurred, resulting in an all-cause mortality rate of 13%. RP demonstrated a survival benefit compared with NLT, particularly in patients younger than 74 years of age. In contrast, radiation treatments (EBRT and PSI) did not improve survival in the younger age groups, except for patients older than 70 years for EBRT and older than 65 years for PSI. Notably, EBRT in patients younger than 65 years was associated with inferior outcomes.
CONCLUSIONS: This study highlights the differences in survival outcomes among LRPC treatment modalities. RP was associated with improved survival compared to NLT, especially in younger patients. In contrast, EBRT and PSI showed survival benefits primarily in the older age groups. NLT is a reasonable choice, particularly in younger patients when RP is not chosen. These findings emphasize the importance of individualized treatment decisions for LRPC management.
摘要：
背景：低风险前列腺癌（LRPC）的最佳治疗方法仍存在争议。虽然主动监视是一种越来越受欢迎的选择，确定的局部治疗，包括根治性前列腺切除术（RP），外束放射治疗（EBRT），和前列腺种子植入（PSI），也是常用的。本研究旨在使用国家癌症数据库（NCDB）中的大量患者来评估LRPC患者的生存结果。
方法：我们使用NCDB分析了2004年至2015年间诊断为LRPC的195,452例患者的数据。根据患者的治疗方式进行分类，包括RP,EBRT,PSI,或没有局部治疗（NLT）。仅包括Charlson-Deyo合并症评分为0或1的患者，以确保可比性。倾向评分分析用于平衡治疗组，采用加速失效时间模型分析各治疗组的生存率。
结果：中位随访70.8个月后，发生24,545人死亡,导致13％的全因死亡率。与NLT相比，RP显示出生存益处，特别是年龄小于74岁的患者。相比之下,放射治疗（EBRT和PSI）没有改善年轻年龄组的生存率，除了70岁以上的EBRT患者和65岁以上的PSI患者。值得注意的是,65岁以下患者的EBRT与不良预后相关。
结论：本研究强调了LRPC治疗模式之间生存结局的差异。与NLT相比，RP与生存率改善相关，尤其是年轻患者。相比之下,EBRT和PSI主要在老年群体中显示出生存益处。NLT是一个合理的选择，特别是在未选择RP的年轻患者中。这些发现强调了个性化治疗决策对LRPC管理的重要性。
方法：我们使用NCDB分析了2004年至2015年间诊断为LRPC的195,452例患者的数据。根据患者的治疗方式进行分类，包括RP,EBRT,PSI,或没有局部治疗（NLT）。仅包括Charlson-Deyo合并症评分为0或1的患者，以确保可比性。倾向评分分析用于平衡治疗组，采用加速失效时间模型分析各治疗组的生存率。
结果：中位随访70.8个月后，发生24,545人死亡,导致13％的全因死亡率。与NLT相比，RP显示出生存益处，特别是年龄小于74岁的患者。相比之下,放射治疗（EBRT和PSI）没有改善年轻年龄组的生存率，除了70岁以上的EBRT患者和65岁以上的PSI患者。值得注意的是,65岁以下患者的EBRT与不良预后相关。
结论：本研究强调了LRPC治疗模式之间生存结局的差异。与NLT相比，RP与生存率改善相关，尤其是年轻患者。相比之下,EBRT和PSI主要在老年群体中显示出生存益处。NLT是一个合理的选择，特别是在未选择RP的年轻患者中。这些发现强调了个性化治疗决策对LRPC管理的重要性。
