Association between prostate radiotherapy and survival among patients with metastatic prostate cancer by extent of disease burden

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-21 DOI:10.1016/j.radonc.2025.111158

Peter S. Palencia , Shayan Smani , Xiwen Zhao , Keervani Kandala , Nethusan Sivanesan , Jaime A. Cavallo , Navid Roessler , Sanjay Aneja , Yi An , Marcin Miszczyk , Michael S. Leapman

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Abstract

Background and objective

Prostate radiotherapy (RT) is increasingly used in the treatment of hormone-sensitive metastatic prostate cancer (PCa) based on evidence of benefit in subsets with low disease volume. However, survival outcomes of patients with metastatic PCa receiving prostate RT across contemporary distributions of stage are less well understood.

Methods

Within the National Cancer Database (2004–2020), we identified individuals with de-novo metastatic PCa treated with hormonal therapy (HT) with or without prostate RT. Kaplan-Meier curves and multivariable proportional hazard regression models were used to compare overall survival (OS) across nodal (M1a), bone (M1b), and visceral (M1c) disease, using propensity score matched (PSM) samples.

Results

We identified 48,121 eligible patients, including 42,437 (88.2 %) patients receiving only HT and 5,684 (11.8 %) patients receiving HT + RT. In PSM-adjusted hazard regression models, RT was associated with improved OS (HR: 0.62; 95 % CI: 0.58–0.66; p < 0.001). The association differed by metastatic substage; the risk of death was reduced in patients with M1a (HR: 0.48; 95 % CI: 0.39–0.58; p < 0.001) and M1b disease (HR: 0.60; 95 % CI: 0.56–0.65; p < 0.001). No significant OS benefit was observed in M1c disease (HR: 0.91; 95 % CI: 0.74–1.13; p < 0.001).

Conclusion

Prostate RT with HT was associated with improved survival in this observational study of patients with metastatic PCa. However, these associations differed by metastatic substage, with greater benefit in M1a, and no apparent benefit in M1c disease. In the era of molecular imaging, further refinement of patient selection for prostate RT may optimize treatment benefit.

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前列腺放射治疗与转移性前列腺癌患者生存的关系

背景和目的：前列腺放射治疗（RT）越来越多地用于治疗激素敏感转移性前列腺癌（PCa），有证据表明其对低疾病体积亚群有益。然而，转移性前列腺癌患者在不同时期接受前列腺放射治疗的生存结果尚不清楚。方法：在国家癌症数据库（2004-2020）中，我们确定了接受激素治疗（HT）伴有或不伴有前列腺癌的转移性前列腺癌患者。Kaplan-Meier曲线和多变量比例风险回归模型使用倾向评分匹配（PSM）样本比较淋巴结（M1a）、骨（M1b）和脏器（M1c）疾病的总生存率（OS）。结果：我们确定了48,121例符合条件的患者，包括42,437例（88.2 %）仅接受HT治疗的患者和5,684例（11.8 %）接受HT + 放疗的患者。在经psm校正的风险回归模型中，放疗与改善的OS相关（HR: 0.62; 95 % CI: 0.58-0.66; p ）结论：在这项转移性前列腺癌患者的观察性研究中，前列腺放疗联合HT与改善的生存率相关。然而，这些关联因转移亚分期而异，在M1a疾病中获益更大，而在M1c疾病中无明显获益。在分子成像时代，进一步细化前列腺放射治疗的患者选择可以优化治疗效果。

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

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.