Definition and Validation of “Favorable High-Risk Prostate Cancer”: Implications for Personalizing Treatment of Radiation-Managed Patients

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• 作者：Vinayak Muralidhar ; MSc^&lowast ; ; Ming-Hui Chen ; PhD^&dagger ; ; Gally Reznor ; MS^&Dagger ; ; Brian J. Moran ; MD^§ ; ; Michelle H. Braccioforte ; MPH^§ ; ; Clair J. Beard ; MD^‖ ; Felix Y. Feng ; MD^¶ ; ; Karen E. Hoffman ; MD ; MHSc ; MPH^# ; Toni K. Choueiri ; MD^&lowast ; &lowast ; ; Neil E. Martin ; MD ; MPH^‖ ; Christopher J. Sweeney ; MBBS^&lowast ; &lowast ; ; Quoc-Dien Trinh ; MD^&dagger ; &dagger ; ; Paul L. Nguyen ; MD^‖ ; ^{pnguyen@LROC.harvard.edu" class="auth_mail" title="E-mail the corresponding author}
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2015
• 出版时间：15 November 2015
• 年：2015
• 卷：93
• 期：4
• 页码：828-835
• 全文大小：373 K

文摘

To define and validate a classification of favorable high-risk prostate cancer that could be used to personalize therapy, given that consensus guidelines recommend similar treatments for all radiation-managed patients with high-risk disease.

<h4 id="absSec_2">Methods and Materialsh4>

We studied 3618 patients with cT1-T3aN0M0 high-risk or unfavorable intermediate-risk prostate adenocarcinoma treated with radiation at a single institution between 1997 and 2013. Favorable high-risk was defined as T1c disease with either Gleason 4 + 4 = 8 and prostate-specific antigen <10 ng/mL or Gleason 6 and prostate-specific antigen >20 ng/mL. Competing risks regression was used to determine differences in the risk of prostate cancer&ndash;specific mortality (PCSM) after controlling for baseline factors and treatment. Our results were validated in a cohort of 13,275 patients using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.

<h4 id="absSec_3">Resultsh4>

Patients with favorable high-risk disease had significantly better PCSM than other men with high-risk disease (adjusted hazard ratio [AHR] 0.42, 95% confidence interval [CI] 0.18-0.996, P=.049) and similar PCSM as men with unfavorable intermediate-risk disease (AHR 1.17, 95% CI 0.50-2.75, P=.710). We observed very similar results within the SEER-Medicare cohort (favorable high-risk vs other high-risk: AHR 0.21, 95% CI 0.11-0.41, P<.001; favorable high-risk vs unfavorable intermediate-risk: AHR 0.67, 95% CI 0.33-1.36, P=.268).

<h4 id="absSec_4">Conclusionsh4>

Patients with favorable high-risk prostate cancer have significantly better PCSM than other patients with high-risk disease and similar PCSM as those with unfavorable intermediate-risk disease, who are typically treated with shorter-course androgen deprivation therapy. This new classification system may allow for personalization of treatment within high-risk disease, such as consideration of shorter-course androgen deprivation therapy for favorable high-risk disease.