Clinical Outcomes for Radiographic Node-Positive Prostate Cancer Following Definitive Radiotherapy

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association Pub Date : 2025-09-01 DOI:10.1016/j.jnma.2025.08.070

Jade K. Dodge MS, Lily Boe PhD, Kevin Boehm MD, PhD, David Guttmann MD, Zachary Moore MD, PhD, Dhwani Parikh MD, Andrew Barsky MD, Marisa Kollmeier MD, Sean McBride MD, MPH, Victoria Brennan MBBch, Jeremy Setton MD, Daniel Gorovets MD, Himanshu Nagar MD, James Janopaul-Naylor MD

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引用次数: 0

Abstract

Background

The incidence of regional lymph node metastases at diagnosis is approximately 15%. Androgen deprivation therapy (ADT) with radiotherapy (RT) remains a standard treatment option, but long-term effects and outcomes are understudied.

Methods

Data was retrospectively collected from 304 subjects with radiographic node-positive prostate cancer treated with RT from 2014-2024. Covariates include use of androgen receptor signaling inhibitors (ARSI), use of brachytherapy boost to primary disease in prostate, pre- RT PSA, and Gleason Score (GS). Endpoints included biochemical progression (bPFS), distant metastases free survival (DMFS) and overall survival (OS). Kaplan-Meier method, log rank test, univariate (UVA) and multivariate regression analyses (MVA) were used for time to event endpoints.

Results

Patient features are summarized in table. 48% of patients had ECOG 0. On MVA, GS 9-10 was significantly associated with worse OS (HR 2.26, 95%CI 1.15 – 4.43, p=0.02), DMFS (HR 2.37, 95%CI 1.32 – 4.24, p<0.01), and bPFS (HR 2.10, 95%CI 1.23 – 3.59, p<0.01). Worse performance status was associated with significantly worse OS (HR 3.14, 95%CI 1.35 – 7.29, p<0.01) and trend for worse DMFS (HR 2.03, 95%CI 0.95 – 4.35, p=0.07) and bPFS (HR 2.01, 95%CI 0.99 – 4.07, p=0.05). Radiation boost dose to involved lymph nodes was significantly associated with OS (p=0.03) and DMFS (p=0.03) but not bPFS. There were no other statistically significant associations on MVA. There was no significant association on UVA between pre-radiation maximum PSA and OS, DMFS, or bPFS.

Conclusion

In this cohort of patients treated with ADT and definitive RT, 5-year DMFS was 67%. Gleason score and age were the strongest prognostic features. There was no significant association, but numerically higher survival seen with use of ARSI or brachytherapy boost. Future work characterizing patterns of care and failure is needed to help optimize management.

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前列腺癌淋巴结阳性放射治疗后的临床结果

诊断时区域淋巴结转移的发生率约为15%。雄激素剥夺疗法（ADT）与放射治疗（RT）仍然是一种标准的治疗选择，但长期效果和结果尚未得到充分研究。方法回顾性收集2014-2024年304例放疗治疗的淋巴结阳性前列腺癌患者的资料。协变量包括雄激素受体信号抑制剂（ARSI）的使用、近距离放疗对前列腺原发疾病的促进作用、RT前PSA和Gleason评分（GS）。终点包括生化进展（bPFS）、无远处转移生存（DMFS）和总生存（OS）。Kaplan-Meier法、对数秩检验、单变量（UVA）和多变量回归分析（MVA）用于时间到事件终点。结果患者特征总结如表所示。48%的患者ECOG为0。在MVA上，GS 9-10与较差的OS （HR 2.26, 95%CI 1.15 - 4.43, p=0.02）、DMFS （HR 2.37, 95%CI 1.32 - 4.24, p= 0.01）和bPFS （HR 2.10, 95%CI 1.23 - 3.59, p= 0.01）显著相关。较差的运动状态与较差的OS （HR 3.14, 95%CI 1.35 ~ 7.29, p= 0.01）以及较差的DMFS （HR 2.03, 95%CI 0.95 ~ 4.35, p=0.07）和bPFS （HR 2.01, 95%CI 0.99 ~ 4.07, p=0.05）相关。受累淋巴结的辐射增强剂量与OS （p=0.03）和DMFS （p=0.03）显著相关，但与bPFS无关。在MVA方面没有其他统计学意义的关联。辐射前最大PSA与OS、DMFS或bPFS之间的UVA无显著相关性。结论在接受ADT和最终RT治疗的患者中，5年DMFS为67%。Gleason评分和年龄是最重要的预后特征。没有明显的相关性，但使用ARSI或近距离治疗的生存率较高。未来的工作特征的护理和失败的模式，以帮助优化管理。

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

Journal of the National Medical Association 医学-医学：内科

CiteScore

4.80

自引率

3.00%

发文量

139

审稿时长

98 days

期刊介绍： Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.