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Abstract
Aim. Assessment of prognostic factors for survival in prostate cancer (PC) patients after external beam radiation therapy (EBRT) from 2016 to 2022 (an in-depth population study); comparison of outcomes of conformal and non-conformal radiotherapy for PC.
Materials and Methods. A total of 1 118 records of stage 1-4 PC patients who received EBRT between 2016 and 2022 were selected for analysis from the population registry of the Arkhangelsk region. Details of pathomorphological examination and EBRT were extracted by combining the population registry database with the databases of the pathology department and hospital registry of the Arkhangelsk Oncology Dispensary. Biochemical relapse-free survival (BRFS) was assessed using an actuarial method with an assessment of 1- and 5-year survival and a log-rank method to compare survival in subgroups. A Cox proportional hazards regression model was used to assess the degree of influence of prognostic factors on cancer-specific survival.
Results. The overall and cancer-specific 5-year survival in the cohort was 71.3 % (95 % confidence interval (CI) 66.8-75.3 %) and 91.1 % (95 % CI 87.6-93.6 %), respectively. By the time of the analysis, 145 patients had a biochemical relapse. The five-year BRFS was 81.2 % (95 % CI 77.8-84.1 %). In the multivariate Cox regression model, after adjusting for all the studied factors, the prognosis is significantly influenced by the stage (HR at stage II-IV 5.28, p = 0.019), the risk group (with intermediate and high risk HR 3.83, p = 0.033 and 4.67, p = 0.015) and the Gleason group (HR 3.50 for groups 2-5, p < 0.0001) compared with the reference stage I, low/very low risk group and Gleason group 1. The use of conformal EBRT led to a 45 % reduction in the risk of biochemical progression compared with non-conformal irradiation.
Conclusion. In a high-resolution epidemiological study, stage, Gleason group and age were found to be independent prognostic factors of BRFS in radiotherapy for localized PC. Modern conformal radiotherapy halves the risk of progression.
References
Global cancer observatory. WHO IARC.-URL: https://gco.iarc.fr/ (18.02.2024).
Pernar C.H., Ebot E.M., Wilson K.M. The epidemiology of prostate cancer. Cold Spring Harb Perspect Med. 2018; 8(12): a030361.-DOI: https://doi.org/10.1101/cshperspect.a030361.
Каприн А.Д., Старинский В.В., Шахзадова А.О. Злокачественные новообразования в России в 2021 году. Заболеваемость и смертность. М.: 2022: 252. [Kaprin A.D., Starinsky V.V., Shakhzadova A.O. Malignant neoplasms in Russia in 2021. Morbidity and mortality. M.: 2022: 252. (In Rus)].
Клинические рекомендации. Рак предстательной железы. Российское общество урологов. Ассоциация онкологов России. Российское общество онкоурологов. Российское общество клинической онкологии. 2021. [Clinical recommendations. Prostate cancer. The Russian Society of Urologists. Association of Oncologists of Russia. The Russian Society of Oncourologists. Russian Society of Clinical Oncology. 2021. (In Rus)].
Abdollah F., Sun M., Schmitges J. Competing-risks mortality after radiotherapy vs. observation for localized prostate cancer: a population-based study. Int J Radiat Oncol Biol Phys. 2012; 84(1): 95-103.-DOI: https://doi.org/10.1016/j.ijrobp.2011.11.034.
Bandini M., Pompe R.S., Marchioni M. Radical prostatectomy or radiotherapy reduce prostate cancer mortality in elderly patients: a population-based propensity score adjusted analysis. World J Urol. 2018; 36(1): 7-13.-DOI: https://doi.org/10.1007/s00345-017-2102-9.
Новиков С.Н., Канаев С.В., Новиков Р.В. Брахитерапия рака предстательной железы источником высокой мощности дозы в режиме монотерапии: анализ пятилетних результатов. Вопросы онкологии. 2020; 66(4): 404-412.-DOI: https://doi.org/10.37469/0507-3758-2020-66-4-404-412. [Novikov S.N., Kanaev S.V., Novikov R.V. Brachytherapy of prostate cancer as a source of high dose rate in monotherapy mode: an analysis of five-year results. Voprosy Onkologii = Problems in Oncology. 2020; 66(4): 404-412.-DOI: https://doi.org/10.37469/0507-3758-2020-66-4-404-412. (In Rus)].
Киприянов Е.А., Карнаух П.А., Важенин И.А. Эффективность применения лучевых методов лечения пациентов с локализованным раком предстательной железы в условиях одного стационара. Онкоурология. 2017; 13(2): 74-78.-DOI: https://doi.org/10.17650/1726-9776-2017-13-2-74-78. [Kipriyanov E.A., Karnauh P.A., Vazhenin I.A. The effectiveness of radiotherapy in patients with localized prostate cancer in a single hospital setting. Oncourology. 2017; 13(2): 74-78.-DOI: https://doi.org/10.17650/1726-9776-2017-13-2-74-78. (In Rus)].
Wang Y., Gieschen H., Greenberger M. Survival after robotic-assisted prostatectomy for localized prostate cancer: an epidemiologic study. Ann Surg. 2021; 274(6): e507-e514.-DOI: https://doi.org/10.1097/SLA.0000000000003637.
Allemani C., Matsuda T., Di Carlo V. CONCORD Working Group. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018; 17; 391(10125): 1023-1075.-DOI: https://doi.org/10.1016/S0140-6736(17)33326-3.
Жаринов Г.М., Зимин А.А., Самойлова К.А. Выживаемость больных раком предстательной железы после дистанционной лучевой терапии и низкоинтенсивной фототерапии ближним инфракрасным светом. Вопросы онкологии. 2011; 57(4): 457-461. [Zharinov G.M., Zimin A.A., Samoilova K.A. Survival of patients with prostate cancer after remote radiation therapy and low-intensity phototherapy with near infrared light. Voprosy Onkologii = Problems in Oncology. 2011; 57(4): 457-461. (In Rus)].
Wallis C.J.D., Saskin R, Choo R. Surgery versus radiotherapy for clinically-localized prostate cancer: a systematic review and meta-analysis. EurUrol. 2016; 70(1): 21-30.-DOI: https://doi.org/10.1016/j.eururo.2015.11.010.
Шабанов М.А., Потапова А.В., Гладилина И.А. Морфологические факторы риска прогрессирования у больных раком предстательной железы после лучевой терапии. Урология. 2020; 1: 68-75.-DOI: https://doi.org/10.18565/urology.2020.1.68-74. [Shabanov M.A., Potapova A.V., Gladilina I.A. Morphological risk factors for progression in patients with prostate cancer after radiation therapy. Urology. 2020; 1: 68-75.-DOI: https://doi.org/10.18565/urology.2020.1.68-74. (In Rus)].
Pearlstein K.A., Basak R., Chen R.C. Comparative effectiveness of prostate cancer treatment options: limitations of retrospective analysis of cancer registry data. Int J Radiat Oncol Biol Phys. 2019; 103(5): 1053-1057.-DOI: https://doi.org/10.1016/j.ijrobp.2018.08.001.
Lawler M., Davies L., Oberst S. European Groundshot-addressing Europe's cancer research challenges: a Lancet Oncology Commission. Lancet Oncol. 2023; 24(1): 11-56.-DOI: https://doi.org/10.1016/S1470-2045(22)00540-X.
Roach M. 3rd, Hanks G., Thames H.Jr., et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006; 65(4): 965-74.-DOI: https://doi.org/10.1016/j.ijrobp.2006.04.029.
Hervás A., Pastor J., González C. Outcomes and prognostic factors in intermediate-risk prostate cancer: multi-institutional analysis of the Spanish RECAP database. Clin Transl Oncol. 2019; 21(7): 900-909.-DOI: https://doi.org/10.1007/s12094-018-02000-y.
Oh J., Morris W.J., Spadinger I. After ASCENDE-RT: Biochemical and survival outcomes following combined external beam radiotherapy and low-dose-rate brachytherapy for high-risk and unfavourable intermediate-risk prostate cancer, a population-based analysis. Brachytherapy. 2022; 21(5): 605-616.-DOI: https://doi.org/10.1016/j.brachy.2022.05.002.
Андреева Р.Д., Низамова РС, Корабельников АС. Влияние индекса Глисона на выживаемость больных локализованным раком предстательной железы в Самарской области. Вестник медицинского института «РЕАВИЗ». Реабилитация, Врач и Здоровье. 2022; 12(2): 90-97.-DOI: https://doi.org/10.20340/vmi-rvz.2022.1.CLIN.2. [Andreeva R.T., Nizamova R.S., Korabelnikov A.S. The effect of the Gleason index on the survival of patients with localized prostate cancer in the Samara region. Bulletin of the medical institute "REAVIZ". Rehabilitation, Doctor and Health. 2022; 12(2): 90-97.-DOI: https://doi.org/10.20340/vmi-rvz.2022.1.CLIN.2. (In Rus)].
Michalski J.M., Moughan J., Purdy J., et al. Effect of standard vs dose-escalated radiation therapy for patients with intermediate-risk prostate cancer. JAMA Oncology. 2018; 4(6): e180039.-DOI: https://doi.org/10.1001/jamaoncol.2018.0039.
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