Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, Milan, Rozzano, Italy.
Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy.
J Cancer Res Clin Oncol. 2019 Oct;145(10):2469-2479. doi: 10.1007/s00432-019-03007-w. Epub 2019 Aug 23.
The aim of the present study was to provide predictive factors for survival outcomes of oligometastatic prostate cancer (PC) patients treated with stereotactic body radiation therapy (SBRT) as a metastases-directed therapy (MDT).
In this cohort study, endpoints included overall survival (OS), progression-free survival (PFS), distant progression-free survival (DFS) and local control of treated metastases (LC). The binary classification tree approach with recursive partitioning analysis (RPA) was applied to stratify the patients into risk groups based on OS, PFS and DPFS; for each endpoint, disease-free interval (DFI) was calculated. We included patients with synchronous or metachronous metastases from prostate adenocarcinoma treated with SBRT.
119 Metastases were treated with SBRT in 92 patients. Median follow-up was 22.2 months. Rates of OS at 1 and 3 years were 96.9% and 88.0%, while DPFS was 51.9% and 20.9%. Recursive partitioning analysis identified three prognostic classes for OS: Class 1: castration-sensitive patients (3 years OS 95%); Class 2: castration-resistant patients with low-intermediate risk NCCN disease (3 years OS 88.8%); Class 3: castration-resistant patients with high-risk NCCN disease (3 years OS 76.9%). Regarding DPFS, RPA divided patients into two classes, according to a cutoff value of DFI of 34 months (3 years PFS of 28.7% vs 5.8%). Three classes were identified for DPFS: Class 1: DFI < 34 months (3 years DPFS 9.1%); Class 2: DFI > 34 months and high-risk NCCN PC (3 years DPFS 21%); Class 3: DFI > 34 months and low-intermediate risk NCCN disease (3 years DPFS 60.2%).
Oligometastatic PC represents nowadays a setting of particular interest in which local ablative therapies play a decisive role. In the present study, we recognized the importance of DFI, together with NCCN class risk, to predict the risk of new metastases after SBRT in oligometastatic PC.
本研究旨在为接受立体定向体放射治疗（SBRT）作为转移灶定向治疗（MDT）的寡转移前列腺癌（PC）患者的生存结果提供预测因素。
在这项队列研究中，终点包括总生存期（OS）、无进展生存期（PFS）、远处无进展生存期（DFS）和治疗转移灶的局部控制（LC）。应用二分类树方法和递归分区分析（RPA），根据 OS、PFS 和 DFS 将患者分为风险组；对于每个终点，计算无疾病间隔（DFI）。我们纳入了接受 SBRT 治疗的前列腺腺癌同步或异时转移的患者。
92 例患者的 119 个转移灶接受了 SBRT 治疗。中位随访时间为 22.2 个月。1 年和 3 年的 OS 率分别为 96.9%和 88.0%，DFS 率分别为 51.9%和 20.9%。递归分区分析确定了 OS 的三个预后类别：1 类：去势敏感患者（3 年 OS 为 95%）；2 类：低中危 NCCN 疾病的去势抵抗患者（3 年 OS 为 88.8%）；3 类：高危 NCCN 疾病的去势抵抗患者（3 年 OS 为 76.9%）。关于 DFS，RPA 根据 DFI 的截断值 34 个月（3 年 PFS 为 28.7%比 5.8%）将患者分为两类。根据 DFS 确定了三个类别：1 类：DFI<34 个月（3 年 DFS 为 9.1%）；2 类：DFI>34 个月和高危 NCCN PC（3 年 DFS 为 21%）；3 类：DFI>34 个月和低中危 NCCN 疾病（3 年 DFS 为 60.2%）。
寡转移 PC 目前是一个特别引人关注的领域，局部消融治疗在此发挥了决定性作用。在本研究中，我们认识到 DFI 与 NCCN 风险分类一起对预测寡转移 PC 患者 SBRT 后新转移灶的风险具有重要意义。
