Radical Prostatectomy With and Without Neoadjuvant Chemohormonal Pretreatment for High-Risk Localized Prostate Cancer: A Comparative Propensity Score Matched Analysis.
Aged
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Cohort Studies
Combined Modality Therapy
Docetaxel
/ administration & dosage
Estramustine
/ administration & dosage
Follow-Up Studies
Humans
Male
Neoadjuvant Therapy
/ mortality
Propensity Score
Prostate-Specific Antigen
/ blood
Prostatectomy
/ mortality
Prostatic Neoplasms
/ pathology
Survival Rate
Treatment Outcome
Combined androgen blockade
Docetaxel
Estramustine phosphate
Neoadjuvant chemotherapy
Prostatectomy
Journal
Clinical genitourinary cancer
ISSN: 1938-0682
Titre abrégé: Clin Genitourin Cancer
Pays: United States
ID NLM: 101260955
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
15
05
2018
revised:
29
08
2018
accepted:
22
09
2018
pubmed:
6
11
2018
medline:
8
8
2019
entrez:
5
11
2018
Statut:
ppublish
Résumé
To investigate the clinical outcomes in patients with high-risk prostate cancer (PCa) treated with neoadjuvant chemohormonal therapy (NCHT) before radical prostatectomy (RP). Our NCHT protocol involved complete androgen blockade followed by 6 cycles of docetaxel (30 mg/m In the NCHT group, 10.0% experienced pathologic complete response, 3.3% had positive surgical margins, and 13.3% developed severe complications (Clavien-Dindo grade III or higher) after RP. The median follow-up duration was 42.5 months, and the 5-year biochemical recurrence (BCR)-free survival was 60.1%. In multivariate analysis, pN+ was an independent prognostic factor for BCR (hazard ratio = 5.251, 95%CI 1.300-21.201; P = .020). In propensity score matching, the BCR rate in the NCHT group was significantly lower than that in the RP alone group (P = .021). In subgroup analyses, the BCR rate in patients with a single high-risk factor was significantly lower in the NCHT group than in the RP-alone group (P = .027). NCHT before RP can reduce the risk of BCR in patients with high-risk PCa, particularly if a single high-risk factor is present. However, the potential for perioperative complications should be considered.
Sections du résumé
BACKGROUND
BACKGROUND
To investigate the clinical outcomes in patients with high-risk prostate cancer (PCa) treated with neoadjuvant chemohormonal therapy (NCHT) before radical prostatectomy (RP).
PATIENTS AND METHODS
METHODS
Our NCHT protocol involved complete androgen blockade followed by 6 cycles of docetaxel (30 mg/m
RESULTS
RESULTS
In the NCHT group, 10.0% experienced pathologic complete response, 3.3% had positive surgical margins, and 13.3% developed severe complications (Clavien-Dindo grade III or higher) after RP. The median follow-up duration was 42.5 months, and the 5-year biochemical recurrence (BCR)-free survival was 60.1%. In multivariate analysis, pN+ was an independent prognostic factor for BCR (hazard ratio = 5.251, 95%CI 1.300-21.201; P = .020). In propensity score matching, the BCR rate in the NCHT group was significantly lower than that in the RP alone group (P = .021). In subgroup analyses, the BCR rate in patients with a single high-risk factor was significantly lower in the NCHT group than in the RP-alone group (P = .027).
CONCLUSION
CONCLUSIONS
NCHT before RP can reduce the risk of BCR in patients with high-risk PCa, particularly if a single high-risk factor is present. However, the potential for perioperative complications should be considered.
Identifiants
pubmed: 30391137
pii: S1558-7673(18)30393-8
doi: 10.1016/j.clgc.2018.09.019
pii:
doi:
Substances chimiques
Docetaxel
15H5577CQD
Estramustine
35LT29625A
Prostate-Specific Antigen
EC 3.4.21.77
Types de publication
Comparative Study
Journal Article
Langues
eng
Pagination
e113-e122Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.