Abstract
Purpose/Objectives
We aimed to develop nomograms to predict the risk reduction for metastasis and death
in pathologically node-positive (pN +) prostate cancer patients treated with or without
radiation therapy (RT).
Materials/Methods
From a prospectively gathered institutional database, we identified patients with
pN + M0 prostate cancer after surgery. We evaluated several regression models of known
or suspected clinical-pathologic covariates and selected the model with the highest
Harrell's concordance-index (c-index) and clinical utility to prognosticate metastasis
for inclusion in a nomogram. Covariates in the final, competing-risk adjusted, metastasis
model included PSA nadir after surgery, pathologic T-stage, margin status, Gleason
score (GS), number of positive lymph nodes, and use of postoperative radiotherapy
combined with androgen deprivation therapy (RT + ADT). The overall survival model
also included Charlson comorbidity score and age.
Results
336 pN + men with a mean age of 64.9 years and a median follow-up of 4.1 years who
had a radical prostatectomy were included in the analysis. 83 men were recommended
RT + ADT, of whom 4% refused the ADT and received RT alone. C-index was 0.85 and 0.71
for the MFS and OS models, respectively. On multivariable analysis (MVA) adjusted
for competing risks, RT + ADT significantly improved MFS (HR=0.70 P = < .01) with number of nodes positive, GS 8-10, PSA nadir > 1 ng/mL, and pT3b prognostic
for metastasis. MVA for OS demonstrates RT+ADT improves survival (HR=0.40, P = .02), with GS8-10 and PSA nadir > 1.0 prognostic for death.
Conclusion
We developed predictive nomograms for patients with pN+ prostate cancer following
radical prostatectomy. These models can discretely quantify an individual's risk of
metastasis or death with and without post-prostatectomy radiotherapy.
Keywords
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References
NCCN Clinical Practice Guidelines in Oncology – Prostate Cancer, version 1.2020, 2020. Accessed 4/21/2020, https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf.
- Randomized trial of adjuvant radiotherapy following radical prostatectomy versus radical prostatectomy alone in prostate cancer patients with positive margins or extracapsular extension.Eur Urol. 2019; 76: 586-595https://doi.org/10.1016/j.eururo.2019.07.001
- Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial.J Urol. 2009; 181: 956-962https://doi.org/10.1016/j.juro.2008.11.032
- Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96-02/AUO AP 09/95 trial.Eur Urol. 2014; 66: 243-250https://doi.org/10.1016/j.eururo.2014.03.011
- Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911).Lancet (London, England). 2012; 380: 2018-2027https://doi.org/10.1016/s0140-6736(12)61253-7
- Short-term androgen deprivation therapy combined with radiotherapy as salvage treatment after radical prostatectomy for prostate cancer (GETUG-AFU 16): a 112-month follow-up of a phase 3, randomised trial.Lancet Oncol. 2019; 20: 1740-1749https://doi.org/10.1016/s1470-2045(19)30486-3
- Radiation with or without antiandrogen therapy in recurrent prostate cancer.N Engl J Med. 2017; 376: 417-428https://doi.org/10.1056/NEJMoa1607529
- Short term androgen deprivation therapy without or with pelvic lymph node treatment added to prostate bed only salvage radiotherapy: The NRG Oncology/RTOG 0534 SPPORT Trial.Int J Radiat Oncol*Biol*Phys. 2018; 102: 1605https://doi.org/10.1016/j.ijrobp.2018.08.052
- Impact of adjuvant radiotherapy on survival of patients with node-positive prostate cancer.J Clin Oncol. 2014; 32: 3939-3947https://doi.org/10.1200/JCO.2013.54.7893
- Long-term follow-up of patients with prostate cancer and nodal metastases treated by pelvic lymphadenectomy and radical prostatectomy: the positive impact of adjuvant radiotherapy.Eur Urol. 2009; 55: 1003-1011https://doi.org/10.1016/j.eururo.2009.01.046
- Combination of adjuvant hormonal and radiation therapy significantly prolongs survival of patients with pT2-4 pN+ prostate cancer: results of a matched analysis.Eur Urol. 2011; 59: 832-840https://doi.org/10.1016/j.eururo.2011.02.024
- Androgen deprivation with or without radiation therapy for clinically node-positive prostate cancer.J Natl Cancer Inst. 2015; 107https://doi.org/10.1093/jnci/djv119
- The role of adjuvant radiotherapy in pathologically lymph node-positive prostate cancer.Cancer. 2017; 123: 512-520
- Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy.Lancet Oncol. 2006; 7: 472-479https://doi.org/10.1016/s1470-2045(06)70700-8
Granfors T, Modig H, Damber J-E, Tomic R. Long-term followup of a randomized study of locally advanced prostate cancer treated with combined orchiectomy and external radiotherapy versus radiotherapy alone. 2006;176:544-547. doi:10.1016/j.juro.2006.03.092w.
- Nonparametric estimation from incomplete observations.J Am Statist Assoc. 1958; 53: 457-481https://doi.org/10.2307/2281868
- Metastasis, mortality, and quality of life for men with NCCN high and very high risk localized prostate cancer following surgical and/or combined modality radiation therapies.Clin Genitourin Cancer. 2020; https://doi.org/10.1016/j.clgc.2019.11.023
- Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.Stat Med. 1996; 15: 361-387https://doi.org/10.1002/(sici)1097-0258(19960229)15:4<361::Aid-sim168>3.0.Co;2-4
- A proportional hazards model for the subdistribution of a competing risk.J Am Statist Assoc. 1999; 94: 496-509
- Regression models and life-tables.J Royal Statist Soc Series B (Methodological). 1972; 34: 187-220
- Absolute versus relative benefit of androgen deprivation therapy for prostate cancer: moving beyond the hazard ratio to personalize therapy.Int J Radiat Oncol Biol Phys. 2020; 108: 899-902https://doi.org/10.1016/j.ijrobp.2020.06.011
- Patterns of clinical recurrence of node-positive prostate cancer and impact on long-term survival.Eur Urol. 2015; 68: 777-784https://doi.org/10.1016/j.eururo.2015.04.035
- Temporal trends and predictors in diagnosing pathologic node-positive prostate cancer in clinically node-negative patients.Clin Genitourin Cancer. 2021; https://doi.org/10.1016/j.clgc.2021.05.003
- Selecting the optimal candidate for adjuvant radiotherapy after radical prostatectomy for prostate cancer: a long-term survival analysis.Eur Urol. 2013; 63: 998-1008https://doi.org/10.1016/j.eururo.2012.10.036
- Addition of radiation therapy to androgen ablation improves outcome for subclinically node-positive prostate cancer.Urology. 2001; 58: 233-239https://doi.org/10.1016/s0090-4295(01)01168-2
- Predicting survival of patients with node-positive prostate cancer following multimodal treatment.Eur Urol. 2014; 65: 554-562https://doi.org/10.1016/j.eururo.2013.09.025
- Survival outcomes of men with lymph node-positive prostate cancer after radical prostatectomy: a comparative analysis of different postoperative management strategies.Eur Urol. 2018; 73 (Eur Urol. Jul 2018;74(1):e18-e19): 890-896https://doi.org/10.1016/j.eururo.2018.04.002
- Patterns of care and outcomes of radiotherapy for lymph node positivity after radical prostatectomy.BJU Int. 2013; 111: 1208-1214https://doi.org/10.1111/bju.12079
- The role of prostate-specific antigen persistence after radical prostatectomy for the prediction of clinical progression and cancer-specific mortality in node-positive prostate cancer patients.Eur Urol. 2016; 69: 1142-1148https://doi.org/10.1016/j.eururo.2015.12.010
- Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era.J Urol. 2007; 178 (discussion 870-1): 864-870https://doi.org/10.1016/j.juro.2007.05.048
- Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer. A new proposal based on a two-institution experience on 703 consecutive N+ patients treated with radical prostatectomy, extended pelvic lymph node dissection and adjuvant therapy.Eur Urol. 2009; 55: 261-270https://doi.org/10.1016/j.eururo.2008.09.043
- Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results.J Urol. 2004; 172: 2252-2255https://doi.org/10.1097/01.ju.0000143448.04161.cc
- Prostate specific antigen (PSA) persistence 6 weeks after radical prostatectomy and pelvic lymph node dissection as predictive factor of radiographic progression in node-positive prostate cancer patients.J Cancer. 2019; 10: 2237-2242https://doi.org/10.7150/jca.29714
- Lymph node ratio determines the benefit of adjuvant radiotherapy in pathologically 3 or less lymph node-positive prostate cancer after radical prostatectomy: a population-based analysis with propensity-score matching.Oncotarget. 2017; 8: 110625-110634https://doi.org/10.18632/oncotarget.22610
- Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy.J Clin Oncol. 2007; 25: 2035-2041https://doi.org/10.1200/JCO.2006.08.9607
- Contemporary update of a multi-institutional predictive nomogram for salvage radiotherapy after radical prostatectomy.J Clin Oncol. 2016; 34: 3648-3654https://doi.org/10.1200/JCO.2016.67.9647
Testing the Addition of the Drugs, Apalutamide and Abiraterone Acetate With Prednisone, to the Usual Hormone Therapy and Radiation Therapy After Surgery for Prostate Cancer.
Article Info
Publication History
Published online: February 07, 2022
Accepted:
January 29,
2022
Received in revised form:
January 14,
2022
Received:
October 7,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
