Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death
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Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death. / Tilki, Derya; Chen, Ming-Hui; Wu, Jing; Huland, Hartwig; Graefen, Markus; Wiegel, Thomas; Böhmer, Dirk; Mohamad, Osama; Cowan, Janet E; Feng, Felix Y; Carroll, Peter R; Trock, Bruce J; Partin, Alan W; D'Amico, Anthony V.
in: J CLIN ONCOL, Jahrgang 39, Nr. 20, 10.07.2021, S. 2284-2293.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Adjuvant Versus Early Salvage Radiation Therapy for Men at High Risk for Recurrence Following Radical Prostatectomy for Prostate Cancer and the Risk of Death
AU - Tilki, Derya
AU - Chen, Ming-Hui
AU - Wu, Jing
AU - Huland, Hartwig
AU - Graefen, Markus
AU - Wiegel, Thomas
AU - Böhmer, Dirk
AU - Mohamad, Osama
AU - Cowan, Janet E
AU - Feng, Felix Y
AU - Carroll, Peter R
AU - Trock, Bruce J
AU - Partin, Alan W
AU - D'Amico, Anthony V
PY - 2021/7/10
Y1 - 2021/7/10
N2 - PURPOSE: Adjuvant compared with early salvage radiation therapy (sRT) following radical prostatectomy (RP) has not been shown to reduce progression-free survival in randomized controlled trials. However, these trials might have missed a benefit in men with adverse pathology at RP given that these men were under-represented and immortal time bias might have been present; herein, we investigate this possibility.METHODS: We evaluated the impact of adjuvant versus early sRT on all-cause mortality (ACM) risk in men with adverse pathology defined as positive pelvic lymph nodes (pN1) or pGleason score 8-10 prostate cancer (PC) and disease extending beyond the prostate (pT3/4). We used a treatment propensity score to minimize potential treatment selection bias when estimating the causal effect of adjuvant versus early sRT on ACM risk and a sensitivity analysis to assess the impact that varying definitions of adverse pathology had on ACM risk adjusting for age at RP, PC prognostic factors, site, and the time-dependent use of post-RP androgen deprivation therapy.RESULTS: After a median follow-up (interquartile range) of 8.16 (6.00-12.10) years, of the 26,118 men in the study cohort, 2,104 (8.06%) died, of which 539 (25.62%) were from PC. After excluding men with a persistent prostate-specific antigen, adjuvant compared with early sRT was associated with a significantly lower ACM risk among men with adverse pathology at RP when men with pN1 PC were excluded (0.33 [0.13-0.85]; P = .02) or included (0.66 [0.44-0.99]; P = .04).CONCLUSION: Adjuvant radiation therapy should be considered in men with pN1 or pGleason score 8 to 10 and pT3/4 PC given the possibility that a significant reduction in ACM risk exists.
AB - PURPOSE: Adjuvant compared with early salvage radiation therapy (sRT) following radical prostatectomy (RP) has not been shown to reduce progression-free survival in randomized controlled trials. However, these trials might have missed a benefit in men with adverse pathology at RP given that these men were under-represented and immortal time bias might have been present; herein, we investigate this possibility.METHODS: We evaluated the impact of adjuvant versus early sRT on all-cause mortality (ACM) risk in men with adverse pathology defined as positive pelvic lymph nodes (pN1) or pGleason score 8-10 prostate cancer (PC) and disease extending beyond the prostate (pT3/4). We used a treatment propensity score to minimize potential treatment selection bias when estimating the causal effect of adjuvant versus early sRT on ACM risk and a sensitivity analysis to assess the impact that varying definitions of adverse pathology had on ACM risk adjusting for age at RP, PC prognostic factors, site, and the time-dependent use of post-RP androgen deprivation therapy.RESULTS: After a median follow-up (interquartile range) of 8.16 (6.00-12.10) years, of the 26,118 men in the study cohort, 2,104 (8.06%) died, of which 539 (25.62%) were from PC. After excluding men with a persistent prostate-specific antigen, adjuvant compared with early sRT was associated with a significantly lower ACM risk among men with adverse pathology at RP when men with pN1 PC were excluded (0.33 [0.13-0.85]; P = .02) or included (0.66 [0.44-0.99]; P = .04).CONCLUSION: Adjuvant radiation therapy should be considered in men with pN1 or pGleason score 8 to 10 and pT3/4 PC given the possibility that a significant reduction in ACM risk exists.
KW - Aged
KW - Clinical Decision-Making
KW - Databases, Factual
KW - Disease Progression
KW - Germany
KW - Humans
KW - Lymphatic Metastasis
KW - Male
KW - Middle Aged
KW - Neoplasm Grading
KW - Neoplasm Staging
KW - Progression-Free Survival
KW - Prospective Studies
KW - Prostatectomy/adverse effects
KW - Prostatic Neoplasms/mortality
KW - Radiotherapy, Adjuvant
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Salvage Therapy/adverse effects
KW - Time Factors
KW - Time-to-Treatment
KW - United States
U2 - 10.1200/JCO.20.03714
DO - 10.1200/JCO.20.03714
M3 - SCORING: Journal article
C2 - 34086480
VL - 39
SP - 2284
EP - 2293
JO - J CLIN ONCOL
JF - J CLIN ONCOL
SN - 0732-183X
IS - 20
ER -