Clinical characteristics and prognostic factors of low metastatic burden prostate cancer with non-regional lymph node metastases: role of cytoreductive radiotherapy?

IF 1.9 3区医学 Q4 ANDROLOGY

Translational andrology and urology Pub Date : 2025-02-28 Epub Date: 2025-02-25 DOI:10.21037/tau-24-489

Lixin Mai, Ruiqi Liu, Xinyue Zhang, Qiwen Pan, Lingling Cai, Wufei Cao, Yonghong Li, Fangjian Zhou, Jianming Gao, Yang Liu, Liru He

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引用次数: 0

Abstract

Background: Low metastatic burden prostate cancer (LMBPC) is a special transitional clinical status between localized and disseminated disease, but the clinical prognostic factors and potential therapeutic interventions of those with non-regional lymph node metastases (NRLNM) remain less understood. We aim to explore the prognostic factors and investigate the potential treatment strategy for LMBPC patients with NRLNM.

Methods: There were 88 patients retrospectively identified. Kaplan-Meier method and Cox proportional hazards model were used for prognostic analyses. Patients receiving non-regional lymph node (NRLN) radiotherapy (NRLN RT group) after prostate-directed local therapy were matched to patients without NRLN RT (control group) by propensity score matching (PSM).

Results: The majority of patients had Gleason score >8 (61.4%), retroperitoneal metastases (93.2%), upward NRLNM (78.4%) and hormone-sensitive prostate cancer (HSPC) (68.2%) at diagnosis. Patients with upward NRLNM showed better survival outcome (75.4 vs. 32.8 months, P=0.04). HSPC [hazard ratio (HR) =0.32, P=0.003], bone metastases (HR =3.79, P<0.001), androgen-receptor-axis-targeted agents (ARATAs) (HR =0.40, P=0.007), and notably, NRLN RT (HR =0.23, P=0.001) were independent prognostic factors of overall survival (OS). The median follow-up was 43.3 months. The prostate-specific antigen (PSA) response and median progression-free survival (PFS) after NRLN RT were 70.6% and 29.5 months. The 4-year OS for NRLN RT group and control group were 62% and 46% (P=0.04). After PSM, NRLN RT was still associated with improved OS (HR =0.39, P=0.04). No grade ≥3 NRLN RT-related adverse event was observed.

Conclusions: Upward NRLNM was the main pattern for LMBPC with NRLNM and associated with better clinical outcome. HSPC, bone metastases, ARATAs and NRLN RT were independent prognostic factors. Applying cytoreductive RT to NRLNM may benefit LMBPC patients. Further studies are still needed.

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低转移负荷前列腺癌伴非区域淋巴结转移的临床特点及预后因素：细胞减少放疗的作用？

背景：低转移负担前列腺癌（LMBPC）是一种介于局部和播散性疾病之间的特殊过渡临床状态，但非区域淋巴结转移（NRLNM）患者的临床预后因素和潜在的治疗干预措施尚不清楚。我们的目的是探讨LMBPC合并NRLNM患者的预后因素和潜在的治疗策略。方法：对88例患者进行回顾性分析。采用Kaplan-Meier法和Cox比例风险模型进行预后分析。采用倾向评分匹配（PSM）方法将前列腺定向局部治疗后接受非区域淋巴结（NRLN）放疗的患者（NRLN RT组）与未接受NRLN RT的患者（对照组）进行匹配。结果：绝大多数患者在诊断时Gleason评分为bb0.8(61.4%)，腹膜后转移（93.2%），NRLNM上升（78.4%），激素敏感性前列腺癌（HSPC）（68.2%）。NRLNM上行的患者生存率更高（75.4个月vs 32.8个月，P=0.04）。HSPC[危险比(HR) =0.32， P=0.003]、骨转移（HR =3.79， P）。结论：NRLNM向上转移是LMBPC合并NRLNM的主要方式，临床预后较好。HSPC、骨转移、ARATAs和NRLN RT是独立的预后因素。对NRLNM应用细胞减量化放疗可能有利于LMBPC患者。还需要进一步的研究。

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来源期刊

Translational andrology and urology Medicine-Urology

CiteScore

4.10

自引率

5.00%

发文量

期刊介绍： ranslational Andrology and Urology (Print ISSN 2223-4683; Online ISSN 2223-4691; Transl Androl Urol; TAU) is an open access, peer-reviewed, bi-monthly journal (quarterly published from Mar.2012 - Dec. 2014). The main focus of the journal is to describe new findings in the field of translational research of Andrology and Urology, provides current and practical information on basic research and clinical investigations of Andrology and Urology. Specific areas of interest include, but not limited to, molecular study, pathology, biology and technical advances related to andrology and urology. Topics cover range from evaluation, prevention, diagnosis, therapy, prognosis, rehabilitation and future challenges to urology and andrology. Contributions pertinent to urology and andrology are also included from related fields such as public health, basic sciences, education, sociology, and nursing.