JAMA:前列腺癌放疗加用ADT益处因人而异

美国Brigham妇女医院D’Amico等报告，与单纯放疗相比，放疗联合雄激素抑制治疗(ADT)可降低前列腺癌患者全因死亡率，但患者如有中至重度合并症，上述联合治疗的优势则不复存在。相关论文发表于《美国医学协会期刊》（JAMA）上。

206例前列腺癌患者（中位年龄72岁）被随机分成ADT加三维适形放疗组和单纯放疗组。患者癌症分期为T1b~2bN0M0，并至少具有一项不良预后特征（前列腺特异性抗原>10 ng/ml、Gleason评分7~10、影像学示包囊外进展或精囊腺侵犯）。157例患者无或仅有轻度合并症，49例患者有中至重度合并症（被平均分配至两组）。

经过时间为7.6年的随访，单纯放疗组和联合治疗组各有44例和30例患者死亡，其中无或仅有轻度合并症患者死亡42例（27%），而有中至重度合并症患者则死亡32例（64%）。与联合治疗组相比，单纯放疗组全因死亡危险显著增加（风险比1.8，P=0.01）。但是，单纯放疗组全因死亡危险增加主要集中于无合并症和有轻症合并症患者（P<0.001），在有中至重度合并症患者中，两种治疗方案的全因死亡率无显著性差异（P=0.08）。

研究再次证实，放疗联合ADT可使前列腺癌患者得到生存益处，但有中至重度合并症患者未能从ADT中获益。目前仍未明确的主要问题是，ADT能否以及如何与导致高合并症评分的各种情况相互作用。（来源：中国医学论坛报）

生物谷推荐原始出处：

（JAMA），2008;299(3):289-295，Anthony V. D’Amico，Philip W. Kantoff

Androgen Suppression and Radiation vs Radiation Alone for Prostate Cancer

Anthony V. D’Amico, MD, PhD; Ming-Hui Chen, PhD; Andrew A. Renshaw, MD; Marian Loffredo, RN, OCN; Philip W. Kantoff, MD

Context Comorbidities may increase the negative effects of specific anticancer treatments such as androgen suppression therapy (AST).

Objectives To compare 6 months of AST and radiation therapy (RT) to RT alone and to assess the interaction between level of comorbidity and all-cause mortality.

Design, Setting, and Patients At academic and community-based medical centers in Massachusetts, between December 1, 1995, and April 15, 2001, 206 men with localized but unfavorable-risk prostate cancer were randomized to receive RT alone or RT and AST combined. All-cause mortality estimates stratified by randomized treatment group and further stratified in a postrandomization analysis by the Adult Comorbidity Evaluation 27 comorbidity score were compared using a log-rank test.

Main Outcome Measure Time to all-cause mortality.

Results As of January 15, 2007, with a median follow-up of 7.6 (range, 0.5-11.0) years, 74 deaths have occurred. A significant increase in the risk of all-cause mortality (44 vs 30 deaths; hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.1-2.9; P = .01) was observed in men randomized to RT compared with RT and AST. However, the increased risk in all-cause mortality appeared to apply only to men randomized to RT with no or minimal comorbidity (31 vs 11 deaths; HR, 4.2; 95% CI, 2.1-8.5; P < .001). Among men with moderate or severe comorbidity, those randomized to RT alone vs RT and AST did not have an increased risk of all-cause mortality (13 vs 19 deaths; HR, 0.54; 95% CI, 0.27-1.10; P = .08).

Conclusions The addition of 6 months of AST to RT resulted in increased overall survival in men with localized but unfavorable-risk prostate cancer. This result may pertain only to men without moderate or severe comorbidity, but this requires further assessment in a clinical trial specifically designed to assess this interaction.