Impact of testosterone recovery after androgen deprivation therapy on overall survival in patients with high-risk prostate cancer: Long-term data from a phase III trial.
Notice bibliographique
Résumé
310 Background: To determine the potential impact of persistent hypogonadism on overall survival (OS) after prolonged androgen deprivation therapy (ADT) in patients (pts) with high-risk prostate cancer. Methods: From 10/2000 to 01/2008, 630 pts were randomised to pelvic radiotherapy (RT) plus 36 (310 pts) vs. 18 months (320 pts) of ADT. Serum testosterone (T) was prospectively collected at baseline, then regularly. We defined T recovery as a return of T to within the normal range value of each participating institution, regardless of whether it was initially normal or abnormal. Excluded from the analysis were pts not receiving exactly 18 or 36 months of ADT (48), or had no T measured at baseline or during follow-up (67). We compared OS between patients recovering or not T to a normal level using the log rank test. Multivariable analysis to predict OS included recovered T to a normal level, age, Zubrod, comorbidities, baseline PSA, Gleason score, stage and ADT duration. Results: 515/630 pts had proper T data available (baseline and follow-up) and were retained for the analysis. The results are reported with a median follow-up of 17.4 years. Over a period of 22 years, 6587 T measurements were available. A total of 270/515 pts (52.4%) recovered T to normal level, 188/330 (57%) in the 18-month and 82/185 (44.3%) in the 36-month cohort, p=0.006. Pts not recovering T to a normal level were older, had higher clinical stage and diabetes. Among pts regaining T to a normal level, the median time to T recovery was 3.6 (IQR 2.9-4.9) years.10- and 15-year OS rates were 76% (71-81) and 44% (38-51) for pts recovering T vs. 55% (49-62) and 30% (24-36) for those who did not, p<0.001. A significant lower risk of death favoured pts recovering T when considering the global hazard ratio (HR) [HR (95% CI) = 0.54 (0.44-0.67), p<0.001]. Significant differences in HR for death are maintained for both 18-month [HR = 0.51 (0.39-0.66), p<0.001] and 36-month cohort [HR = 0.58 (0.40-0.84), p=0.004]. In multivariable analyses, the impact of T recovery remains significant for the risk of death [(HR = 0.69 (0.55-0.86), p=0.001], and also for the 18-month [HR = 0.70 (0.53-0.93), p=0.013] and the 36-month cohort [(HR = 0.61 (0.40-0.93), p=0.021]. In a multivariable model, among pts regaining T to a normal level, the time to T recovery had no impact on OS [HR = 0.97 (0.90-1.04), p=0.41]. Of note, there was no significant difference in the rate of death from prostate cancer between pts recovering or not T (11.9% vs. 13.5%, p=0.58). Competing risk analysis confirms this finding [sHR = 0.83 (0.51-1.35), p=0.57]. Conclusions: In high-risk prostate cancer treated with RT and long-term ADT, T recovery to normal level is associated with a significant improvement in overall survival. The increased death rate in pts not recovering T is likely due to causes unrelated to prostate cancer. Clinical trial information: NCT00223171 .
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».