Ogata Takashi, Aizawa Rihito, Abe Hiroyasu, Goto Takayuki, Nakamura Kiyonao, Kita Yuki, Sumiyoshi Takayuki, Murakami Kaoru, Mizuno Kei, Morita Satoshi, Kobayashi Takashi, Mizowaki Takashi
Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine Kyoto University Kyoto Kyoto Japan.
Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine Kyoto University Kyoto Kyoto Japan.
BJUI Compass. 2025 Sep 7;6(9):e70074. doi: 10.1002/bco2.70074. eCollection 2025 Sep.
To develop a novel risk score (RS) model to predict the probability of progression to castration-resistant prostate cancer (PCa) (CRPC) after intensity-modulated radiation therapy (IMRT) for patients with high- and very high-risk PCa according to the National Comprehensive Cancer Network (NCCN) risk classification, since accurate prediction of the clinical outcome of definitive radiation therapy for patients with high- and very high-risk PCa remains challenging due to its heterogeneity.
We conducted a retrospective review of 600 patients with high- and very high-risk PCa treated with IMRT at our institution. They were randomly divided into discovery (n = 300) and validation (n = 300) cohorts. A predictive RS model was created using a dataset from the discovery cohort based on the following parameters: T-stage, Gleason score, prostate-specific antigen and age at initiation of IMRT. The model was internally validated using a dataset from the validation cohort. RS was calculated using multivariable Cox regression analysis, and patients were categorized into low-risk, intermediate-risk or high-risk based on the value.
The median follow-up period of the 600 patients was 9.1 (IQR: 6.1-11.6) years. The 10-year CRPC-free rates for low-, intermediate- and high-risk categories were 100.0, 90.4 and 61.4% in the discovery cohort, respectively (p < 0.001). Such differences were reproduced in the validation cohort. Specifically, those rates for low-, intermediate- and high-risk categories were 96.4, 90.7 and 74.8% in the validation cohort, respectively (p < 0.001). Harrell's C-index for this model was 0.692, being higher than that of the NCCN risk classification (0.617).
This RS model provided useful information to enable tailoring of the treatment intensity for this heterogeneous population.
根据美国国立综合癌症网络（NCCN）风险分类，为高危和极高危前列腺癌（PCa）患者开发一种新型风险评分（RS）模型，以预测调强放射治疗（IMRT）后进展为去势抵抗性前列腺癌（CRPC）的概率，因为高危和极高危PCa患者确定性放射治疗临床结局的准确预测因其异质性仍然具有挑战性。
我们对在本机构接受IMRT治疗的600例高危和极高危PCa患者进行了回顾性研究。他们被随机分为发现队列（n = 300）和验证队列（n = 300）。基于以下参数，使用发现队列的数据集创建了一个预测RS模型：T分期、Gleason评分、前列腺特异性抗原以及IMRT开始时的年龄。该模型使用验证队列的数据集进行内部验证。使用多变量Cox回归分析计算RS，并根据该值将患者分为低风险、中风险或高风险类别。
600例患者的中位随访期为9.1（四分位间距：6.1 - 11.6）年。在发现队列中，低风险、中风险和高风险类别的10年无CRPC率分别为100.0%、90.4%和61.4%（p < 0.001）。这些差异在验证队列中重现。具体而言，在验证队列中，低风险、中风险和高风险类别的这些比率分别为96.4%、90.7%和74.8%（p < 0.001）。该模型的Harrell's C指数为0.692，高于NCCN风险分类的C指数（0.617）。
该RS模型提供了有用信息，以便为这一异质性人群量身定制治疗强度。
