OLDER AGE PREDICTS DECREASED METASTASIS AND PROSTATE CANCER-SPECIFIC DEATH FOR MEN TREATED WITH RADIATION THERAPY: META-ANALYSIS OF RADIATION THERAPY ONCOLOGY GROUP TRIALS

被引:39
作者
Hamstra, Daniel A. [1 ]
Bae, Kyounghwa [2 ]
Pilepich, Miljenko V. [3 ]
Hanks, Gerald E. [4 ]
Grignon, David J. [5 ]
McGowan, David G. [6 ]
Roach, Mack [7 ]
Lawton, Colleen [8 ]
Lee, R. Jeffrey [9 ]
Sandler, Howard [10 ]
机构
[1] Univ Michigan, Med Ctr, Dept Radiat Oncol, Ann Arbor, MI 48109 USA
[2] Radiat Therapy Oncol Grp, Philadelphia, PA USA
[3] UCLA Med Ctr, Los Angeles, CA USA
[4] Fox Chase Canc Ctr, Philadelphia, PA 19111 USA
[5] Indiana Univ Purdue Univ, Indianapolis, IN 46202 USA
[6] Cross Canc Inst, Edmonton, AB T6G 1Z2, Canada
[7] UCSF, San Francisco, CA USA
[8] Med Coll Wisconsin, Milwaukee, WI 53226 USA
[9] Intermt Med Ctr, Salt Lake City, UT USA
[10] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2011年 / 81卷 / 05期
关键词
Prostate cancer; Radiation therapy; Hormonal ablation; Age; Metastasis; PHASE-III TRIAL; LOCALLY ADVANCED-CARCINOMA; ANDROGEN DEPRIVATION; COMPETING RISK; DEFINITIVE RADIOTHERAPY; SURVIVAL; POPULATION; ADJUVANT; ANTIGEN; NEOADJUVANT;
D O I
10.1016/j.ijrobp.2010.07.2004
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: The impact of age on prostate cancer (PCa) outcome has been controversial; therefore, we analyzed the effect of age on overall survival (OS), distant metastasis, prostate cancer-specific death (PCSD), and nonprostate cancer death (NPCD) on patients with locally advanced PCa. Methods and Materials: Patients who participated in four Radiation Therapy Oncology Group (irroc) phase 111 trials, 8531, 8610, 920.2, and 9413; were studied. Cox proportional hazards regression was used for OS analysis, and cumulative events analysis with Fine and Gray's regression was used for analyses of metastasis, PCSD, and NPCD. Results: Median follow-up of 4,128 patients with median age of 70 (range, 43-88 years) was 7.3 years. Most patients had high-risk disease: cT3 to cT4 (54%) and Gleason scores (GS) of 7(45%) and 8 to 10(27%). Older age (<= 70 vs. >70 years) predicted for decreased OS (10-year rate, 55% vs. 41%, respectively; p <0.000.1) and increased NPCD (10-year rate, 28% vs. 46%, respectively; p < 0.0001) but decreased metastasis (10-year rate, 27% vs. 20%, respectively; p < 0.0001) and PCSD (10-year rate, 1.8% vs. 14%, respectively; p < 0.0001). To account for competing risks, outcomes were analyzed in 2-year intervals, and age-dependent differences in metastasis and PCSD persisted, even in the earliest time periods. When adjusted for other covariates, an age of >70 years remained associated with decreased OS (hazard ratio [HR], 1.56 1,95% confidence interval [CI] 1.43-1.70] p < 0.0901) but with decreased metastasis (HR, 0.72 [95% CI, 0.63-0.83] p < 0.090.1) and PCSD (HR, 0.78 [95% CI, 0.66-0.92] p <0.01)01). Finally, the impact of the duration of androgen deprivation therapy as a function of age was evaluated. Conclusions: These data support less aggressive PCa in older men, independent of other clinical features. While the biological underpinning of this finding remains unknown, stratification by age in future trials appears to be warranted. (C) 2011 Elsevier Inc.
引用
收藏
页码:1293 / 1301
页数:9
相关论文
共 30 条
[1]  
AARONSON D, 2009, BJU INT
[2]   Recent increase in cancer survival according to age: higher survival in all age groups, but widening age gradient [J].
Brenner, H ;
Arndt, V .
CANCER CAUSES & CONTROL, 2004, 15 (09) :903-910
[3]   Influence of age and prostate-specific antigen on the chance of curable prostate cancer among men with nonpalpable disease [J].
Carter, HB ;
Epstein, JI ;
Partin, AW .
UROLOGY, 1999, 53 (01) :126-130
[4]  
Collett D, 1994, MODELLING SURVIVAL D
[5]  
COX DR, 1972, J R STAT SOC B, V34, P187
[6]   A proportional hazards model for the subdistribution of a competing risk [J].
Fine, JP ;
Gray, RJ .
JOURNAL OF THE AMERICAN STATISTICAL ASSOCIATION, 1999, 94 (446) :496-509
[7]   Trends in population-based cancer survival in Germany: to what extent does progress reach older patients? [J].
Gondos, A. ;
Holleczek, B. ;
Arndt, V. ;
Stegmaier, C. ;
Ziegler, H. ;
Brenner, H. .
ANNALS OF ONCOLOGY, 2007, 18 (07) :1253-1259
[8]   A CLASS OF K-SAMPLE TESTS FOR COMPARING THE CUMULATIVE INCIDENCE OF A COMPETING RISK [J].
GRAY, RJ .
ANNALS OF STATISTICS, 1988, 16 (03) :1141-1154
[9]   Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: The Radiation Therapy Oncology Group Protocol 92-02 [J].
Hanks, GE ;
Pajak, TF ;
Porter, A ;
Grignon, D ;
Brereton, H ;
Venkatesan, V ;
Horwitz, EM ;
Lawton, C ;
Rosenthal, SA ;
Sandler, HM ;
Shipley, WU .
JOURNAL OF CLINICAL ONCOLOGY, 2003, 21 (21) :3972-3978
[10]   Age-related prostate cancer metastases [J].
Herold, DM ;
Hanlon, AL ;
Movsas, B ;
Hanks, GE .
UROLOGY, 1998, 51 (06) :985-990