Impact of Cerebrovascular Disease on Survival Benefits from Local Treatment in Patients with De Novo Metastatic Hormone-Sensitive Prostate Cancer
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Purpose: Local treatment has become a treatment option for patients with de novo metastatic hormone-sensitive prostate cancer(mHSPC). Subgroup analyses based on a history of cerebrovascular disease (CVD) were performed to evaluate the impact thereofon overall survival (OS) after local treatment. Materials and Methods: A retrospective analysis was performed for 879 patients with de novo mHSPC between August 2003 andNovember 2016. Patients were stratified according to prior CVD history and the type of initial treatment: androgen-deprivation therapy(ADT) alone versus local treatment consisting of radical prostatectomy (RP) or radiation therapy (RT) with ADT, with or withoutmetastasis-directed therapy. The primary outcome was OS assessed by Kaplan-Meier analysis and Cox-regression models. Results: Of 879 patients, 660 (75.1%) men underwent ADT alone, and 219 (24.9%) men underwent RP or RT with ADT, with or withoutmetastasis-directed therapy. The median follow-up was 38 months. Multivariable analysis showed CVD history to be associatedwith a higher risk of overall mortality (p=0.001). In the overall cohort and in patients without a history of CVD, patients whounderwent local treatment exhibited higher OS than men who received ADT alone (all p<0.001). However, the survival benefit conferredby local treatment was not seen in patients with a history of CVD (p=0.324). OS was comparable between patients who receivedRP and RT (p=0.521). Conclusion: Local treatment with or without metastasis-directed therapy may provide OS advantages for mHSPC patients withouta history of CVD. Further prospective studies are needed to address these important concerns.
Abstract
Purpose: Local treatment has become a treatment option for patients with de novo metastatic hormone-sensitive prostate cancer(mHSPC). Subgroup analyses based on a history of cerebrovascular disease (CVD) were performed to evaluate the impact thereofon overall survival (OS) after local treatment. Materials and Methods: A retrospective analysis was performed for 879 patients with de novo mHSPC between August 2003 andNovember 2016. Patients were stratified according to prior CVD history and the type of initial treatment: androgen-deprivation therapy(ADT) alone versus local treatment consisting of radical prostatectomy (RP) or radiation therapy (RT) with ADT, with or withoutmetastasis-directed therapy. The primary outcome was OS assessed by Kaplan-Meier analysis and Cox-regression models. Results: Of 879 patients, 660 (75.1%) men underwent ADT alone, and 219 (24.9%) men underwent RP or RT with ADT, with or withoutmetastasis-directed therapy. The median follow-up was 38 months. Multivariable analysis showed CVD history to be associatedwith a higher risk of overall mortality (p=0.001). In the overall cohort and in patients without a history of CVD, patients whounderwent local treatment exhibited higher OS than men who received ADT alone (all p<0.001). However, the survival benefit conferredby local treatment was not seen in patients with a history of CVD (p=0.324). OS was comparable between patients who receivedRP and RT (p=0.521). Conclusion: Local treatment with or without metastasis-directed therapy may provide OS advantages for mHSPC patients withouta history of CVD. Further prospective studies are needed to address these important concerns.
참고문헌 (23)
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