Patterns of Recurrence Following Radiation and ADT for Pathologic Lymph Node-Positive Prostate Cancer: A Multi-institutional Study.

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology Pub Date : 2024-12-27 DOI:10.1016/j.prro.2024.12.006

Leslie K Ballas, Chandana A Reddy, Hye Ri Han, Jelena B Makar, Omar Mian, James Broughman, Conchita de Bustamante, Scott Eggener, Stanley L Liauw, Matthew Abramowitz, Christopher Montoya, Rahul Tendulkar

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引用次数: 0

Abstract

Purpose: We evaluate prognostic factors and patterns of recurrence in patients who received RT ± androgen deprivation therapy (ADT) for pathologic node-positive (pN1) prostate cancer (PCa) in a multi-institutional cohort.

Methods and materials: Data from patients with pN1 PCa and received RT with short-term (ST, ≤6 mo) or long-term (LT, >6 mo) ADT were obtained from 4 academic institutions. Biochemical progression-free survival (bPFS) and distant metastasis-free survival (DMFS) were evaluated.

Results: Two hundred seventy patients were included, with a median follow-up of 48 months. Two hundred fifty-six (95%) patients had extracapsular extension, 70% had seminal vesicle invasion, 59% had positive surgical margins, 49% had grade group 5, and 64% had a detectable (>0.1 ng/mL) postoperative prostate-specific antigen (PSA). ADT was ST (20%) or LT (68%, median 24 months), whereas 26 (10%) received no ADT. Biochemical failure (bF) was observed in 29%, with 5% having pelvic nodal failure and 11% having distant metastases. The 4-year bPFS was 72% overall, and was 83% for a pre-RT PSA of <0.1 ng/mL, 76% for PSA 0.1 to <0.5 ng/mL, 60% for PSA 0.5 to 2 ng/mL, and 35% for PSA > 2 ng/mL (P < .0001). On multivariable analysis, pre-RT PSA > 0.5 (0.5-2.0 vs <0.1 hazard ratio (HR), 2.97; >2.0 vs <0.1 HR, 7.63), use of LT ADT versus no ADT (HR, 0.43) and use of LT ADT compared to ST ADT (HR, 0.34), Grade group 4 versus 2 (HR, 4.11), and positive surgical margins (HR, 1.773) were significantly associated with bPFS.

Conclusions: Postprostatectomy RT at PSA < 0.5 ng/mL is associated with favorable bPFS in pN1 PCa.

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病理淋巴结阳性前列腺癌放疗和ADT后复发模式：一项多机构研究。

背景和目的：我们在一个多机构队列中评估病理淋巴结阳性（pN1）前列腺癌（PCa）患者接受RT±雄激素剥夺治疗（ADT）的预后因素和复发模式。方法：来自4个学术机构的pN1型PCa患者的数据，这些患者接受了短期（ST，≤6个月）或长期（LT，≤6个月）ADT的RT治疗。评估无生化进展生存期（bPFS）和无远处转移生存期（DMFS）。主要发现和局限性：纳入270例患者，中位随访时间为48个月。256例（95%）患者有囊外延伸，70%有精囊浸润，59%的手术切缘阳性，49%为5级组，64%的患者术后PSA可检测到（>0.1 ng/mL）。ADT为ST（20%）或LT（68%，中位24个月），26例（10%）未接受ADT治疗。29%的患者出现生化失败（bF）， 5%的患者出现盆腔淋巴结衰竭，11%的患者出现远处转移。总体而言，4年bPFS为72%，放疗前PSA为2 ng/mL （p0.5）为83%（0.5至2.0 vs 2.0 vs）

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

6.10%

发文量

177

审稿时长

34 days

期刊介绍： The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.