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
{"title":"前列腺放射治疗与转移性前列腺癌患者生存的关系","authors":"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","doi":"10.1016/j.radonc.2025.111158","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111158"},"PeriodicalIF":5.3000,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between prostate radiotherapy and survival among patients with metastatic prostate cancer by extent of disease burden\",\"authors\":\"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\",\"doi\":\"10.1016/j.radonc.2025.111158\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":21041,\"journal\":{\"name\":\"Radiotherapy and Oncology\",\"volume\":\"213 \",\"pages\":\"Article 111158\"},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2025-09-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Radiotherapy and Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S016781402505162X\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiotherapy and Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S016781402505162X","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Association between prostate radiotherapy and survival among patients with metastatic prostate cancer by extent of disease burden
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.
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.