Department of Radiation Oncology, Curie Institute, Paris, France.
Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.
Radiother Oncol. 2024 Dec;201:110532. doi: 10.1016/j.radonc.2024.110532. Epub 2024 Sep 13.
Early salvage radiotherapy (SRT) is the standard of care for biochemical recurrence post-prostatectomy but outcomes are heterogeneous.
To develop a risk scoring system based on relevant standard-of-care clinico-pathological prognostic factors for patients treated with SRT with and without hormonal therapy (HT).
DESIGN, SETTING, AND PARTICIPANTS: The Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) database included three randomized trials (Individual patients' data from 1647 subjects) assessing SRT (GETUG-AFU-16; NRG/RTOG-9601, and a subset of EORTC-22911).
Outcomes were clinical progression (CP). metastasis free-survival (MFS) and overall survival (OS). Clinico-pathological factors, including pathological Gleason Score (GS), PSA at SRT start, margin status, persistent PSA post-RP and time from RP to SRT were evaluated by multivariable models stratified by type of treatment.
On multivariable analysis PSA ≥ 0.5 ng/mL at SRT start, GS ≥ 8 and negative margin status were the three strongest prognostic factors. Three prognostic groups defined by number of these risk features (high risk: 2 or 3; intermediate risk: 1 and low risk: 0) were strongly associated with OS, MFS and CP outcomes with SRT alone or with HT. This prognostic group definition was also relevant for patients with persistent PSA post RP and for patients treated < 1 year from RP to SRT and with and without HT.
A risk score for patients receiving SRT with or without HT, using three standard-of-care clinico-pathological risk factors provides refined prognostic information for individual patient counselling.
By using a composite score of pathology grading (Gleason Score), PSA at start of salvage radiation and margin status data, physicians can provide patients with more refined information on the risk of a second relapse after receiving radiation to the prostate bed after a prostatectomy for a rising or persistent PSA, both with and without hormonal therapy.
早期挽救性放疗（SRT）是前列腺癌术后生化复发的标准治疗方法，但结果存在异质性。
建立一种基于 SRT 治疗患者相关标准治疗临床病理预后因素的风险评分系统，包括使用和不使用激素治疗（HT）的患者。
设计、设置和参与者：前列腺癌中期临床终点（ICECaP）数据库包括三项评估 SRT 的随机试验（1647 名患者的个体患者数据）：GETUG-AFU-16；NRG/RTOG-9601 以及 EORTC-22911 的一个子集。
结果是临床进展（CP）。无转移生存（MFS）和总生存（OS）。临床病理因素，包括病理 GS、SRT 开始时 PSA、切缘状态、RP 后 PSA 持续存在和 RP 至 SRT 的时间，通过多变量模型按治疗类型分层进行评估。
多变量分析显示，SRT 开始时 PSA≥0.5ng/ml、GS≥8 和阴性切缘状态是三个最强的预后因素。通过这些风险特征的数量（高危：2 或 3；中危：1；低危：0）定义的三个预后组与单独接受 SRT 或接受 HT 的患者的 OS、MFS 和 CP 结果密切相关。对于 RP 后 PSA 持续存在的患者，以及 RP 后<1 年接受 SRT 治疗的患者，无论是否接受 HT，这种预后组定义也具有相关性。
使用三个标准治疗临床病理危险因素的 SRT 联合或不联合 HT 的患者风险评分，为患者提供了更精细的个体患者咨询预后信息。
通过使用病理分级（Gleason 评分）、挽救性放疗开始时 PSA 和切缘状态数据的综合评分，医生可以为患者提供更精细的信息，了解在前列腺癌根治术后因 PSA 升高或持续升高而接受前列腺床放疗后再次复发的风险，包括是否接受激素治疗。
