Wenzel Mike, Burdenski Katrin, Tselis Nikolaos, Rödel Claus, Brandts Christian, Ahrens Marit, Koellermann Jens, Graefen Markus, Humke Clara, Siech Carolin, Hoeh Benedikt, Banek Severine, Chun Felix K H, Mandel Philipp
Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany.
Department of Urology, Goethe University Hospital Frankfurt, Frankfurt/Main, Germany.
Strahlenther Onkol. 2025 May 6. doi: 10.1007/s00066-025-02400-4.
Outcomes of adjuvant (aRT) or salvage radiation therapy (sRT) after radical prostatectomy are under investigation regarding cancer-control outcomes.
Relying on the University Cancer Center database elaborating differences in metastasis-free (MFS), cancer-specific (CSS) and overall survival (OS) of aRT vs. sRT-treated patients between 2014-2024. Sensitivity analyses addressed high-risk patients with pN1 and/or Gleason score 8-10 and/or pT3-4 stage.
Of 1862 patients, 7.1% underwent aRT and 93% were in the sRT group. Median PSA at sRT was 0.33 ng/ml. Patients with aRT harbored significantly worse baseline tumor and pathological characteristics such as PSA level (12.0 vs. 7.6 ng/ml), Gleason score 9-10 (30% vs. 9.8%), D'Amico high risk prostate cancer (97% vs. 56%), as well as pT3-4, pN1 and positive surgical margins rates (all p < 0.001). Similar observations were made for high-risk patients. No differences were observed for aRT vs. sRT with 60-month MFS rates of 85.1% vs. 95.4% (hazard ratio [HR] 0.60, p = 0.18). 60-months CSS-rates of 96.8% vs. 99.1% and 60-month OS-rates of 91.0% vs. 89.1% respectively (all p ≥ 0.15). Neither sensitivity analyses of high-risk patients nor multivariable adjusted Cox regression models revealed significant differences regarding MFS, CSS or OS in aRT vs. SRT comparison (all p ≥ 0.05), despite aRT showing qualitatively better OS results.
Within real-world setting, patients undergoing aRT harbor wore tumor characteristics. However, these differences did not translate into significant differences of mid-term oncological outcomes, relative to sRT patients. Similar observations were made within analyses of high-risk patients with pT3-4 and/or Gleason 8-10 and/or pN1 stage, nevertheless aRT showed slightly higher OS rates within this subgroup.
根治性前列腺切除术后辅助放疗（aRT）或挽救性放疗（sRT）的癌症控制结局正在研究中。
依据大学癌症中心数据库，阐述2014年至2024年间接受aRT与sRT治疗患者的无转移生存期（MFS）、癌症特异性生存期（CSS）和总生存期（OS）的差异。敏感性分析针对pN1和/或Gleason评分8 - 10分和/或pT3 - 4期的高危患者。
1862例患者中，7.1%接受了aRT，93%在sRT组。sRT时的中位前列腺特异性抗原（PSA）为0.33 ng/ml。接受aRT的患者基线肿瘤和病理特征明显更差，如PSA水平（12.0对vs . 7.6 ng/ml）、Gleason评分9 - 10分（30%对9.8%）、达米科高危前列腺癌（97%对56%），以及pT3 - 4、pN1和手术切缘阳性率（所有p < 0.001）。高危患者也有类似观察结果。aRT与sRT相比，60个月MFS率分别为85.1%和95.4%，未观察到差异（风险比[HR] 0.60，p = 0.18）。60个月CSS率分别为96.8%和99.1%，60个月OS率分别为91.0%和89.1%（所有p≥0.15）。尽管aRT在定性上显示出更好的OS结果，但高危患者的敏感性分析和多变量调整Cox回归模型均未显示aRT与SRT在MFS、CSS或OS方面有显著差异（所有p≥0.05）。
在现实环境中，接受aRT的患者肿瘤特征较差。然而，相对于接受sRT的患者，这些差异并未转化为中期肿瘤学结局的显著差异。在对pT3 - 4和/或Gleason 8 - 10分和/或pN1期高危患者的分析中也有类似观察结果，不过在该亚组中aRT的OS率略高。
