Prognostic factors in post-prostatectomy salvage radiotherapy setting with and without hormonotherapy: An individual patient data analysis of randomized trials from ICECaP database

IF 4.9 1区 医学 Q1 ONCOLOGY Radiotherapy and Oncology Pub Date : 2024-09-13 DOI:10.1016/j.radonc.2024.110532
Pascal Pommier , Wanling Xie , Praful Ravi , Christian Carrie , James J. Dignam , Felix Feng , Paul Sargos , Silke Gillessen Sommer , Daniel E. Spratt , Bertrand Tombal , Hendrik Van Poppel , Christopher Sweeney
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Abstract

Background

Early salvage radiotherapy (SRT) is the standard of care for biochemical recurrence post-prostatectomy but outcomes are heterogeneous.

Objective

To develop a risk scoring system based on relevant standard-of-care clinico-pathological prognostic factors for patients treated with SRT with and without hormonal therapy (HT).

Design, setting, and participants

The Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) database included three randomized trials (Individual patients’ data from 1647 subjects) assessing SRT (GETUG-AFU-16; NRG/RTOG-9601, and a subset of EORTC-22911).

Outcome measurements and statistical analysis

Outcomes were clinical progression (CP). metastasis free-survival (MFS) and overall survival (OS). Clinico-pathological factors, including pathological Gleason Score (GS), PSA at SRT start, margin status, persistent PSA post-RP and time from RP to SRT were evaluated by multivariable models stratified by type of treatment.

Results and limitations

On multivariable analysis PSA ≥ 0.5 ng/mL at SRT start, GS ≥ 8 and negative margin status were the three strongest prognostic factors. Three prognostic groups defined by number of these risk features (high risk: 2 or 3; intermediate risk: 1 and low risk: 0) were strongly associated with OS, MFS and CP outcomes with SRT alone or with HT. This prognostic group definition was also relevant for patients with persistent PSA post RP and for patients treated < 1 year from RP to SRT and with and without HT.

Conclusion

A risk score for patients receiving SRT with or without HT, using three standard-of-care clinico-pathological risk factors provides refined prognostic information for individual patient counselling.

Patient summary

By using a composite score of pathology grading (Gleason Score), PSA at start of salvage radiation and margin status data, physicians can provide patients with more refined information on the risk of a second relapse after receiving radiation to the prostate bed after a prostatectomy for a rising or persistent PSA, both with and without hormonal therapy.

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前列腺切除术后接受或不接受激素治疗的挽救性放疗的预后因素:来自ICECaP数据库的随机试验的个体患者数据分析
背景早期挽救性放射治疗(SRT)是治疗前列腺切除术后生化复发的标准方法,但疗效却不尽相同。目的根据相关的临床病理标准预后因素,为接受SRT治疗和未接受激素治疗(HT)的患者建立风险评分系统。结果测量和统计分析结果为临床进展(CP)、无转移生存期(MFS)和总生存期(OS)。临床病理因素包括病理格里森评分(GS)、SRT开始时的PSA、边缘状态、RP后持续PSA以及从RP到SRT的时间,这些因素通过多变量模型进行评估,并按治疗类型进行分层。根据这些风险特征的数量定义的三个预后组(高风险:2或3;中度风险:1;低风险:0)与单纯SRT或HT的OS、MFS和CP结果密切相关。这一预后分组定义也适用于 RP 后 PSA 持续存在的患者,以及从 RP 到 SRT 治疗 < 1 年的患者,也适用于使用或不使用 HT 的患者。患者总结 通过使用病理分级(Gleason 评分)、开始挽救性放射治疗时的 PSA 和边缘状态数据的综合评分,医生可以为患者提供更精细的信息,帮助他们了解因 PSA 升高或持续存在而接受前列腺切除术后接受前列腺床放射治疗后再次复发的风险,无论是否接受激素治疗。
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来源期刊
Radiotherapy and Oncology
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.
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