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Meta-Analysis
. 2020 Jan;9(1):27-34.
doi: 10.1002/cam4.2605. Epub 2019 Nov 7.

Comparative effectiveness of surgery versus external beam radiation with/without brachytherapy in high-risk localized prostate cancer

Ming Yin  1 , Jing Zhao  2 , Paul Monk  1 , Douglas Martin  3 , Edmund Folefac  1 , Monika Joshi  4 , Ning Jin  1 , Amir Mortazavi  1 , Claire Verschraegen  1 , Steven Clinton  1
Affiliations
Meta-Analysis

Comparative effectiveness of surgery versus external beam radiation with/without brachytherapy in high-risk localized prostate cancer

Ming Yin et al. Cancer Med. 2020 Jan.

Abstract

Background: It remains controversial if radical prostatectomy or definitive radiation therapy produces equivalent outcomes in high-risk localized prostate cancer.

Methods: We queried The Surveillance, Epidemiology, and End Results (SEER) database for those who received upfront surgery or who were recommended for surgery but instead received radiation. Inverse probability of treatment weighing was used to adjust for covariate imbalance and the weighted Cox proportional hazards model was used to estimate the effects of treatment groups on survival. A meta-analysis was performed to pool estimates from published studies.

Results: Among eligible 62 533 patients, 59 540 had upfront surgery and 2993 patients had upfront radiotherapy. EBRT + BT was associated with a superior cancer-specific survival (CSS) compared with surgery or EBRT alone (HR, 0.55, 95% CI, 0.3-1.0; HR, 0.49, 95% CI, 0.24-0.98, respectively), whereas EBRT was associated with an inferior overall survival (OS) compared with surgery (HR, 1.46, 95% CI, 1.16-1.8). Radiotherapy (EBRT ± BT) was inferior to surgery by OS (HR, 1.63, 95% CI, 1.13-2.34) in patients ≤ 65 years, and was superior to surgery by CSS in patients > 65 years (HR, 0.69, 95% CI, 0.49-0.97). The meta-analysis showed consistent results.

Conclusion: EBRT + BT was associated with a significantly better prostate CSS compared with surgery or EBRT. EBRT alone was inferior to surgery by OS.

Keywords: prostate cancer; radiation therapy; surgery; survival.

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Conflict of interest statement

Monika Joshi is a consultant of Bayer and Sanofi, and have research grants sponsored by Pfizer and Astrazeneca. Amir Mortazavi serves in advisory board of Seattle Genetics, Janssen, Debiopharm Group. All others have no conflict of interest relevant to the subject matter or materials discussed in the manuscript.

Figures

Figure 1
Figure 1
CONSORT diagram for the cohort analyzed
Figure 2
Figure 2
Inverse probability of treatment weighting‐adjusted Kaplan‐Meier curves stratified by the three treatments. A. cancer‐specific survival; B, overall survival
Figure 3
Figure 3
Meta‐analysis results. A. EBRT + BT vs EBRT by CSS; B, EBRT vs Surgery by OS; C, EBRT + BT vs Surgery by CSS; D. EBRT + BT vs Surgery by OS
See this image and copyright information in PMC

References

    1. Cooperberg MR, Broering JM, Carroll PR. Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol. 2010;28(7):1117‐1123. - PMC - PubMed
    1. Cooperberg MR, Vickers AJ, Broering JM, Carroll PR. Comparative risk‐adjusted mortality outcomes after primary surgery, radiotherapy, or androgen‐deprivation therapy for localized prostate cancer. Cancer. 2010;116(22):5226‐5234. - PMC - PubMed
    1. Lawton C, Lin X, Hanks GE, et al. Duration of androgen deprivation in locally advanced prostate cancer: long‐term update of NRG oncology RTOG 9202. Int J Radiat Oncol Biol Phys. 2017;98(2):296‐303. - PMC - PubMed
    1. Zapatero A, Guerrero A, Maldonado X, et al. High‐dose radiotherapy with short‐term or long‐term androgen deprivation in localised prostate cancer (DART01/05 GICOR): a randomised, controlled, phase 3 trial. Lancet Oncol. 2015;16(3):320‐327. - PubMed
    1. Kishan AU, Cook RR, Ciezki JP, et al. Radical prostatectomy, external beam radiotherapy, or external beam radiotherapy with brachytherapy boost and disease progression and mortality in patients with gleason score 9–10 prostate cancer. JAMA. 2018;319(9):896‐905. - PMC - PubMed

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