Siech Carolin, von Kriegstein Helge, Wenzel Mike, Cano Garcia Cristina, Le Quynh Chi, Tennstedt Pierre, Preisser Felix, Maurer Tobias, Kriegmair Maximilian, Chun Felix K H, Graefen Markus, Tilki Derya, Mandel Philipp
Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Prostate Cancer Prostatic Dis. 2025 Sep 3. doi: 10.1038/s41391-025-01018-y.
To develop a novel model for preoperatively predicting the indication for adjuvant radiation therapy after radical prostatectomy according to current guideline recommendations of the European Association of Urology (EAU) based on patient and clinical tumor characteristics in high-risk prostate cancer patients.
Within a high-volume center database (01/2010-08/2024), we identified high-risk prostate cancer patients. Univariable logistic regression models addressed indication for adjuvant radiation therapy. Multivariable logistic regression models included the most informative, statistically significant preoperative predictors. Harrell's concordance index (c-index) quantified accuracy after 2000 bootstrap resamples for internal validation.
Of 5691 patients, 2137 (38%) had indication for adjuvant radiation therapy according to current EAU guidelines (2025). Indication for adjuvant radiation therapy was associated with higher prostate volume (> 45 cm and 25-45 cm) and advanced tumor characteristics, namely higher prostate-specific antigen value (>20 ng/ml and 10-20 ng/ml), advanced clinical tumor stage (cT3/4 and cT2), lower number of sampled biopsy cores (≤ 12), higher proportion of positive cores (continuous), and higher Gleason Grade Group in biopsy (5, 4, and 3). No association was observed for age and body-mass index and indication for adjuvant radiation therapy. Multivariable model c-index for the prediction of the indication for adjuvant radiation therapy was 0.761 (95% confidence interval 0.749-0.776).
Clinical tumor characteristics can be used for preoperatively predicting the indication for adjuvant radiation therapy after radical prostatectomy according to current EAU guideline recommendations in high-risk prostate cancer patients. Prior to clinical application, the present multivariable model should be externally validated within an independent cohort.
根据欧洲泌尿外科学会（EAU）当前的指南建议，基于高危前列腺癌患者的患者和临床肿瘤特征，开发一种术前预测根治性前列腺切除术后辅助放疗指征的新模型。
在一个大容量中心数据库（2010年1月至2024年8月）中，我们识别出高危前列腺癌患者。单变量逻辑回归模型分析辅助放疗指征。多变量逻辑回归模型纳入了信息量最大、具有统计学意义的术前预测因素。通过2000次自抽样重采样进行内部验证后，Harrell一致性指数（c指数）量化预测准确性。
在5691例患者中，根据当前EAU指南（2025年），2137例（38%）有辅助放疗指征。辅助放疗指征与前列腺体积较大（>45 cm³和25 - 45 cm³）以及肿瘤特征进展相关，即前列腺特异性抗原值较高（>20 ng/ml和10 - 20 ng/ml）、临床肿瘤分期较晚（cT3/4和cT2）、穿刺活检取材针数较少（≤12针）、阳性针数比例较高（连续变量）以及活检中较高的Gleason分级组（5级、4级和3级）。未观察到年龄、体重指数与辅助放疗指征之间存在关联。预测辅助放疗指征的多变量模型c指数为0.761（95%置信区间0.749 - 0.776）。
根据当前EAU指南建议，临床肿瘤特征可用于术前预测高危前列腺癌患者根治性前列腺切除术后辅助放疗的指征。在临床应用之前，本多变量模型应在独立队列中进行外部验证。
