Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Eur Urol. 2014 Sep;66(3):479-86. doi: 10.1016/j.eururo.2013.11.045. Epub 2013 Dec 12.
Early salvage radiotherapy (eSRT) represents the only curative option for prostate cancer patients experiencing biochemical recurrence (BCR) for local recurrence after radical prostatectomy (RP).
To develop and internally validate a novel nomogram predicting BCR after eSRT in patients treated with RP.
DESIGN, SETTING, AND PARTICIPANTS: Using a multi-institutional cohort, 472 node-negative patients who experienced BCR after RP were identified. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at prostate-specific antigen (PSA) ≤ 0.5 ng/ml.
BCR after eSRT was defined as two consecutive PSA values ≥ 0.2 ng/ml. Uni- and multivariable Cox regression models predicting BCR after eSRT were fitted. Regression-based coefficients were used to develop a nomogram predicting the risk of 5-yr BCR after eSRT. The discrimination of the nomogram was quantified with the Harrell concordance index and the calibration plot method. Two hundred bootstrap resamples were used for internal validation.
Mean follow-up was 58 mo (median: 48 mo). Overall, 5-yr BCR-free survival rate after eSRT was 73.4%. In univariable analyses, pathologic stage, Gleason score, and positive surgical margins were associated with the risk of BCR after eSRT (all p ≤ 0.04). These results were confirmed in multivariable analysis, where all the previously mentioned covariates as well as pre-RT PSA were significantly associated with BCR after eSRT (all p ≤ 0.04). A coefficient-based nomogram demonstrated a bootstrap-corrected discrimination of 0.74. Our study is limited by its retrospective nature and use of BCR as an end point.
eSRT leads to excellent cancer control in patients with BCR for presumed local failure after RP. We developed the first nomogram to predict outcome after eSRT. Our model facilitates risk stratification and patient counselling regarding the use of secondary therapy for individuals experiencing BCR after RP.
Salvage radiotherapy leads to optimal cancer control in patients who experience recurrence after radical prostatectomy. We developed a novel tool to identify the best candidates for salvage treatment and to allow selection of patients to be considered for additional forms of therapy.
对于根治性前列腺切除术（RP）后因局部复发而出现生化复发（BCR）的前列腺癌患者，早期挽救性放疗（eSRT）是唯一的治愈选择。
为了在接受 RP 治疗的患者中，为 eSRT 后发生 BCR 建立并内部验证一种新的预测模型。
设计、设置和参与者：使用多机构队列，确定了 472 例接受 RP 后发生 BCR 的淋巴结阴性患者。所有患者均接受 eSRT，定义为在 PSA≤0.5ng/ml 时对前列腺和精囊床进行局部放疗。
eSRT 后发生 BCR 定义为连续两次 PSA 值≥0.2ng/ml。拟合了预测 eSRT 后发生 BCR 的单变量和多变量 Cox 回归模型。使用回归系数开发了一个预测 eSRT 后 5 年 BCR 风险的列线图。通过 Harrell 一致性指数和校准图方法量化了该列线图的判别能力。使用 200 个 bootstrap 重采样进行内部验证。
平均随访时间为 58 个月（中位数：48 个月）。总体而言，eSRT 后 5 年 BCR 无复发生存率为 73.4%。单变量分析中，病理分期、Gleason 评分和阳性切缘与 eSRT 后发生 BCR 的风险相关（均 p≤0.04）。多变量分析证实了这一结果，先前提到的所有协变量以及 RT 前 PSA 与 eSRT 后发生 BCR 显著相关（均 p≤0.04）。基于系数的列线图显示校正后的判别能力为 0.74。本研究存在回顾性研究和使用 BCR 作为终点的局限性。
eSRT 为 RP 后因局部复发而发生 BCR 的患者提供了极佳的癌症控制效果。我们开发了第一个预测 eSRT 后结局的列线图。我们的模型有助于对接受 RP 后发生 BCR 的个体进行风险分层和二次治疗咨询。
挽救性放疗可使根治性前列腺切除术后复发的患者获得最佳的癌症控制效果。我们开发了一种新的工具，可以识别最适合挽救治疗的候选者，并允许选择患者接受额外形式的治疗。
