Carolin Siech, Helge von Kriegstein, Mike Wenzel, Cristina Cano Garcia, Quynh Chi Le, Pierre Tennstedt, Felix Preisser, Tobias Maurer, Maximilian Kriegmair, Felix K H Chun, Markus Graefen, Derya Tilki, Philipp Mandel
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Multivariable logistic regression models included the most informative, statistically significant preoperative predictors. Harrell's concordance index (c-index) quantified accuracy after 2000 bootstrap resamples for internal validation.</p><p><strong>Results: </strong>Of 5691 patients, 2137 (38%) had indication for adjuvant radiation therapy according to current EAU guidelines (2025). Indication for adjuvant radiation therapy was associated with higher prostate volume (> 45 cm<sup>3</sup> and 25-45 cm<sup>3</sup>) and advanced tumor characteristics, namely higher prostate-specific antigen value (>20 ng/ml and 10-20 ng/ml), advanced clinical tumor stage (cT3/4 and cT2), lower number of sampled biopsy cores (≤ 12), higher proportion of positive cores (continuous), and higher Gleason Grade Group in biopsy (5, 4, and 3). No association was observed for age and body-mass index and indication for adjuvant radiation therapy. Multivariable model c-index for the prediction of the indication for adjuvant radiation therapy was 0.761 (95% confidence interval 0.749-0.776).</p><p><strong>Conclusions: </strong>Clinical tumor characteristics can be used for preoperatively predicting the indication for adjuvant radiation therapy after radical prostatectomy according to current EAU guideline recommendations in high-risk prostate cancer patients. 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引用次数: 0
摘要
背景：根据欧洲泌尿外科协会（EAU）目前的指南建议，基于高危前列腺癌患者的患者和临床肿瘤特征，建立一种新的模型，用于术前预测根治性前列腺切除术后辅助放疗的适应证。方法：在一个大容量的中心数据库（2010年1月- 2024年8月）中，我们确定了高危前列腺癌患者。单变量logistic回归模型探讨了辅助放射治疗的适应症。多变量logistic回归模型包含了信息量最大、统计学意义显著的术前预测因子。Harrell’s concordance index （c-index）量化了2000个bootstrap样本后的准确性，用于内部验证。结果：5691例患者中，2137例（38%）符合当前EAU指南（2025）的辅助放射治疗指征。辅助放疗的适应症与前列腺体积增大（>≥45 cm3和25-45 cm3）和晚期肿瘤特征相关，即前列腺特异性抗原值较高（>≥20 ng/ml和10-20 ng/ml），临床肿瘤分期较晚期（cT3/4和cT2），活检穿刺穿刺数量较少（≤12），阳性穿刺穿刺比例较高（连续），活检Gleason分级组较高（5,4,3）。没有观察到年龄和身体质量指数与辅助放射治疗的适应症相关。预测辅助放疗适应证的多变量模型c指数为0.761（95%可信区间0.749-0.776）。结论：临床肿瘤特征可作为预测高危前列腺癌患者根治性前列腺切除术后辅助放疗适应证的依据。在临床应用之前，目前的多变量模型应该在一个独立的队列中进行外部验证。
Predicting the indication for adjuvant radiation therapy according to EAU guidelines among patients with high-risk prostate cancer: a novel multivariable model.
Background: To develop a novel model for preoperatively predicting the indication for adjuvant radiation therapy after radical prostatectomy according to current guideline recommendations of the European Association of Urology (EAU) based on patient and clinical tumor characteristics in high-risk prostate cancer patients.
Methods: Within a high-volume center database (01/2010-08/2024), we identified high-risk prostate cancer patients. Univariable logistic regression models addressed indication for adjuvant radiation therapy. Multivariable logistic regression models included the most informative, statistically significant preoperative predictors. Harrell's concordance index (c-index) quantified accuracy after 2000 bootstrap resamples for internal validation.
Results: Of 5691 patients, 2137 (38%) had indication for adjuvant radiation therapy according to current EAU guidelines (2025). Indication for adjuvant radiation therapy was associated with higher prostate volume (> 45 cm3 and 25-45 cm3) and advanced tumor characteristics, namely higher prostate-specific antigen value (>20 ng/ml and 10-20 ng/ml), advanced clinical tumor stage (cT3/4 and cT2), lower number of sampled biopsy cores (≤ 12), higher proportion of positive cores (continuous), and higher Gleason Grade Group in biopsy (5, 4, and 3). No association was observed for age and body-mass index and indication for adjuvant radiation therapy. Multivariable model c-index for the prediction of the indication for adjuvant radiation therapy was 0.761 (95% confidence interval 0.749-0.776).
Conclusions: Clinical tumor characteristics can be used for preoperatively predicting the indication for adjuvant radiation therapy after radical prostatectomy according to current EAU guideline recommendations in high-risk prostate cancer patients. Prior to clinical application, the present multivariable model should be externally validated within an independent cohort.
期刊介绍：
Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management.
Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis.
Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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