Chierigo Francesco, Flammia Rocco Simone, Sorce Gabriele, Hoeh Benedikt, Hohenhorst Lukas, Tian Zhe, Saad Fred, Graefen Marcus, Gallucci Michele, Briganti Alberto, Montorsi Francesco, Chun Felix K H, Shariat Shahrokh F, Guano Giovanni, Mantica Guglielmo, Borghesi Marco, Suardi Nazareno, Terrone Carlo, Karakiewicz Pierre I
IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Prostate. 2023 May;83(7):695-700. doi: 10.1002/pros.24505. Epub 2023 Mar 15.
To assess the association between of type and number of D'Amico high-risk criteria (DHRCs) with rates of cancer-specific mortality (CSM) in prostate cancer (PCa) patients treated with external beam radiotherapy (RT).
In the Surveillance, Epidemiology, and End Results database (2004-2016), we identified 34,908 RT patients with at least one DHRCs, namely prostate-specific antigen (PSA) >20 ng/dL (hrPSA), biopsy Grade Group (hrGG) 4-5, clinical T stage (hrcT) ≥T2c. Multivariable Cox regression models (CRM), as well as competing risks regression (CRR) model, which further adjust for other cause mortality, tested the association between DHRCs and 5-year CSM.
Of 34,908 patients, 14,777 (42%) exclusively harbored hrGG, 5641 (16%) hrPSA, 4390 (13%) had hrcT. Only 8238 (23.7%) harbored any combination of two DHRCs and 1862 (5.3%) had all three DHRCs. Five-year CSM rates ranged from 2.4% to 5.0% when any individual DHRC was present (hrcT, hrPSA, hrGG, in that order), versus 5.2% to 10.5% when two DHRCs were present (hrPSA+hrcT, hrcT+hrGG, hrPSA+hrGG, in that order) versus 14.4% when all three DHRCs were identified. In multivariable CRM hazard ratios relative to hrcT ranged from 1.07 to 1.76 for one DHRC, 2.20 to 3.83 for combinations of two DHRCs, and 5.11 for all three DHRCs. Multivariable CRR yielded to virtually the same results.
Our study indicates a stimulus-response effect according to the type and number of DHRCs. This indicates potential for risk-stratification within HR PCa patients that could be applied in clinical decision making to increase or reduce treatment intensity.
评估接受外照射放疗（RT）的前列腺癌（PCa）患者中，达米科高危标准（DHRCs）的类型和数量与癌症特异性死亡率（CSM）之间的关联。
在监测、流行病学和最终结果数据库（2004 - 2016年）中，我们确定了34908例至少有一项DHRCs的RT患者，即前列腺特异性抗原（PSA）>20 ng/dL（高风险PSA，hrPSA）、活检分级组（高风险分级组，hrGG）4 - 5级、临床T分期（高风险T分期，hrcT）≥T2c。多变量Cox回归模型（CRM）以及进一步调整其他死因死亡率的竞争风险回归（CRR）模型，测试了DHRCs与5年CSM之间的关联。
在34908例患者中，14777例（42%）仅存在hrGG，5641例（16%）存在hrPSA，4390例（13%）有hrcT。只有8238例（23.7%）存在两种DHRCs的任意组合，1862例（5.3%）存在所有三种DHRCs。当存在任何一项单独的DHRCs（按此顺序为hrcT、hrPSA、hrGG）时，5年CSM率范围为2.4%至5.0%，当存在两项DHRCs（按此顺序为hrPSA + hrcT、hrcT + hrGG、hrPSA + hrGG）时为5.2%至10.5%，当确定存在所有三项DHRCs时为14.4%。在多变量CRM中，相对于hrcT，一项DHRC的风险比范围为1.07至1.76，两项DHRCs组合的风险比为2.20至3.83，所有三项DHRCs的风险比为5.11。多变量CRR得出了几乎相同的结果。
我们的研究表明，根据DHRCs的类型和数量存在刺激 - 反应效应。这表明在高危PCa患者中进行风险分层具有潜力，可应用于临床决策以增加或降低治疗强度。
