3rd Radiotherapy and Chemotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland.
Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland.
Radiol Oncol. 2021 Mar 25;55(2):203-211. doi: 10.2478/raon-2021-0017.
The aim of the study was to analyse the prognostic factors in postoperative prostate cancer irradiation and develop a nomogram for disease-free survival (DFS).
This retrospective study included 236 consecutive prostate cancer patients who had radical prostatectomy followed by radiotherapy (RT) at a single tertiary institution between 2009 and 2014. The main outcome was DFS analysed through uni- and multivariable analysis, Kaplan-Meier curves, log-rank testing, recursive partitioning analysis, and nomogram development.
The median follow up was 62.3 (interquartile range [IQR] 38.1-79) months. The independent clinical factors associated with increased risk of recurrence or progression in the multivariate analysis (MVA) were prostate-specific antigen (PSA) level before RT, pT3 characteristic, and local failure as salvage indication. The value of PSA nadir had a significant impact on the risk of biochemical failure. Biochemical control and DFS were significantly different depending on treatment indication (p < 0.0001). The recursive partitioning analysis highlighted the importance of the PSA level before RT, Gleason Grade Group, PSA nadir, and local failure as a treatment indication. Finally, the nomogram for DFS was developed and is available online at https://apps.konsta.com.pl/app/prostate-salvage-dfs/.
The Pre-RT PSA level, pT3 characteristic and local failure as salvage indication are pivotal prognostic factors associated with increased risk of recurrence or progression. The Gleason grade group of 4-5 and PSA nadir value allow for further risk stratification. The treatment outcomes in postoperative prostate cancer irradiation are significantly different depending on treatment indication. An online nomogram comprising of both pre-treatment and current data was developed allowing for visualization of changes in prognosis depending on clinical data.
本研究旨在分析前列腺癌术后放疗的预后因素，并建立无病生存（DFS）的列线图。
本回顾性研究纳入了 2009 年至 2014 年期间在一家三级医院接受根治性前列腺切除术和放疗（RT）的 236 例连续前列腺癌患者。主要结局是通过单变量和多变量分析、Kaplan-Meier 曲线、对数秩检验、递归分区分析和列线图开发来分析 DFS。
中位随访时间为 62.3（四分位距[IQR]38.1-79）个月。多变量分析（MVA）中与复发或进展风险增加相关的独立临床因素包括 RT 前 PSA 水平、pT3 特征和局部失败作为挽救性指征。PSA 最低值对生化失败的风险有显著影响。生化控制和 DFS 因治疗指征而异（p<0.0001）。递归分区分析突出了 RT 前 PSA 水平、Gleason 分级组、PSA 最低值和局部失败作为治疗指征的重要性。最后，开发了 DFS 的列线图，并可在 https://apps.konsta.com.pl/app/prostate-salvage-dfs/ 在线获得。
RT 前 PSA 水平、pT3 特征和局部失败作为挽救性指征是与复发或进展风险增加相关的关键预后因素。Gleason 分级组 4-5 和 PSA 最低值可进一步进行风险分层。术后前列腺癌放疗的治疗结果因治疗指征而异。开发了一个包含治疗前和当前数据的在线列线图，可根据临床数据可视化预测结果的变化。
