The association of type and number of high-risk criteria with cancer specific mortality in prostate cancer patients treated with radiotherapy
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The association of type and number of high-risk criteria with cancer specific mortality in prostate cancer patients treated with radiotherapy. / Chierigo, Francesco; Flammia, Rocco Simone; Sorce, Gabriele; Hoeh, Benedikt; Hohenhorst, Lukas; Tian, Zhe; Saad, Fred; Graefen, Marcus; Gallucci, Michele; Briganti, Alberto; Montorsi, Francesco; Chun, Felix K H; Shariat, Shahrokh F; Guano, Giovanni; Mantica, Guglielmo; Borghesi, Marco; Suardi, Nazareno; Terrone, Carlo; Karakiewicz, Pierre I.
In: PROSTATE, Vol. 83, No. 7, 05.2023, p. 695-700.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - The association of type and number of high-risk criteria with cancer specific mortality in prostate cancer patients treated with radiotherapy
AU - Chierigo, Francesco
AU - Flammia, Rocco Simone
AU - Sorce, Gabriele
AU - Hoeh, Benedikt
AU - Hohenhorst, Lukas
AU - Tian, Zhe
AU - Saad, Fred
AU - Graefen, Marcus
AU - Gallucci, Michele
AU - Briganti, Alberto
AU - Montorsi, Francesco
AU - Chun, Felix K H
AU - Shariat, Shahrokh F
AU - Guano, Giovanni
AU - Mantica, Guglielmo
AU - Borghesi, Marco
AU - Suardi, Nazareno
AU - Terrone, Carlo
AU - Karakiewicz, Pierre I
N1 - © 2023 The Authors. The Prostate published by Wiley Periodicals LLC.
PY - 2023/5
Y1 - 2023/5
N2 - BACKGROUND: To assess the association between of type and number of D'Amico high-risk criteria (DHRCs) with rates of cancer-specific mortality (CSM) in prostate cancer (PCa) patients treated with external beam radiotherapy (RT).METHODS: In the Surveillance, Epidemiology, and End Results database (2004-2016), we identified 34,908 RT patients with at least one DHRCs, namely prostate-specific antigen (PSA) >20 ng/dL (hrPSA), biopsy Grade Group (hrGG) 4-5, clinical T stage (hrcT) ≥T2c. Multivariable Cox regression models (CRM), as well as competing risks regression (CRR) model, which further adjust for other cause mortality, tested the association between DHRCs and 5-year CSM.RESULTS: Of 34,908 patients, 14,777 (42%) exclusively harbored hrGG, 5641 (16%) hrPSA, 4390 (13%) had hrcT. Only 8238 (23.7%) harbored any combination of two DHRCs and 1862 (5.3%) had all three DHRCs. Five-year CSM rates ranged from 2.4% to 5.0% when any individual DHRC was present (hrcT, hrPSA, hrGG, in that order), versus 5.2% to 10.5% when two DHRCs were present (hrPSA+hrcT, hrcT+hrGG, hrPSA+hrGG, in that order) versus 14.4% when all three DHRCs were identified. In multivariable CRM hazard ratios relative to hrcT ranged from 1.07 to 1.76 for one DHRC, 2.20 to 3.83 for combinations of two DHRCs, and 5.11 for all three DHRCs. Multivariable CRR yielded to virtually the same results.CONCLUSIONS: Our study indicates a stimulus-response effect according to the type and number of DHRCs. This indicates potential for risk-stratification within HR PCa patients that could be applied in clinical decision making to increase or reduce treatment intensity.
AB - BACKGROUND: To assess the association between of type and number of D'Amico high-risk criteria (DHRCs) with rates of cancer-specific mortality (CSM) in prostate cancer (PCa) patients treated with external beam radiotherapy (RT).METHODS: In the Surveillance, Epidemiology, and End Results database (2004-2016), we identified 34,908 RT patients with at least one DHRCs, namely prostate-specific antigen (PSA) >20 ng/dL (hrPSA), biopsy Grade Group (hrGG) 4-5, clinical T stage (hrcT) ≥T2c. Multivariable Cox regression models (CRM), as well as competing risks regression (CRR) model, which further adjust for other cause mortality, tested the association between DHRCs and 5-year CSM.RESULTS: Of 34,908 patients, 14,777 (42%) exclusively harbored hrGG, 5641 (16%) hrPSA, 4390 (13%) had hrcT. Only 8238 (23.7%) harbored any combination of two DHRCs and 1862 (5.3%) had all three DHRCs. Five-year CSM rates ranged from 2.4% to 5.0% when any individual DHRC was present (hrcT, hrPSA, hrGG, in that order), versus 5.2% to 10.5% when two DHRCs were present (hrPSA+hrcT, hrcT+hrGG, hrPSA+hrGG, in that order) versus 14.4% when all three DHRCs were identified. In multivariable CRM hazard ratios relative to hrcT ranged from 1.07 to 1.76 for one DHRC, 2.20 to 3.83 for combinations of two DHRCs, and 5.11 for all three DHRCs. Multivariable CRR yielded to virtually the same results.CONCLUSIONS: Our study indicates a stimulus-response effect according to the type and number of DHRCs. This indicates potential for risk-stratification within HR PCa patients that could be applied in clinical decision making to increase or reduce treatment intensity.
KW - Male
KW - Humans
KW - Prostatectomy/methods
KW - Prostatic Neoplasms/pathology
KW - Prostate-Specific Antigen
KW - Proportional Hazards Models
KW - Biopsy
U2 - 10.1002/pros.24505
DO - 10.1002/pros.24505
M3 - SCORING: Journal article
C2 - 36919872
VL - 83
SP - 695
EP - 700
JO - PROSTATE
JF - PROSTATE
SN - 0270-4137
IS - 7
ER -
