TY - JOUR
T1 - Comparative effectiveness of surgery versus external beam radiation with/without brachytherapy in high-risk localized prostate cancer
AU - Yin, Ming
AU - Zhao, Jing
AU - Monk, Paul
AU - Martin, Douglas
AU - Folefac, Edmund
AU - Joshi, Monika
AU - Jin, Ning
AU - Mortazavi, Amir
AU - Verschraegen, Claire
AU - Clinton, Steven
N1 - Funding Information:
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.
Publisher Copyright:
© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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.
AB - 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.
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U2 - 10.1002/cam4.2605
DO - 10.1002/cam4.2605
M3 - Article
C2 - 31697452
AN - SCOPUS:85074895801
SN - 2045-7634
VL - 9
SP - 27
EP - 34
JO - Cancer medicine
JF - Cancer medicine
IS - 1
ER -
