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Tumor characteristics influenced impact of adjuvant radiotherapy in prostate cancer
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Tumor characteristics considerably influenced the impact of adjuvant radiotherapy on survival outcomes in patients with node-positive prostate cancer, according to study results.
Firas Abdollah, MD, of the department of urology at Scientific Institute Hospital San Raffaele in Italy, and colleagues sought to assess whether tumor characteristics affected the impact of adjuvant radiotherapy on cancer-specific mortality in patients with pN1 prostate cancer.
The analysis included 1,107 patients treated with radical prostatectomy and anatomically extended pelvic lymph node dissection between 1988 and 2010. All patients received adjuvant hormonal therapy; 35% also received adjuvant radiotherapy.
Mean follow-up was 8.4 years, and median follow-up was 7.1 years.
Researchers reported a cancer-specific mortality-free survival rate of 87.8% at 8 years. The rate was higher among patients treated with adjuvant radiotherapy plus adjuvant hormonal therapy than those who received hormonal therapy alone (92.4% vs. 86.2%; P=.08).
The overall mortality-free rate at 8 years was 78.1%. The rate was higher among those treated with adjuvant radiotherapy plus adjuvant hormonal therapy (87.6% vs. 75.1%; P<.001).
Results of multivariable analysis showed adjuvant radiotherapy was associated with a more favorable rate of cancer-specific mortality-free survival (HR=0.37; P<.001). However, when researchers stratified patients into risk groups, they determined only those at intermediate risk (HR=0.42; 95% CI, 0.25-0.7) or high risk (HR=0.32; 95% CI, 0.12-0.83) benefited from adjuvant radiotherapy.
Patients at intermediate risk included those with two or fewer positive lymph nodes, Gleason score 7 to 10, pT3b/pT4 stage or positive surgical margins. Patients at high risk included those with three to four positive lymph nodes, regardless of other tumor characteristics.
“These results were confirmed when overall mortality was examined as an endpoint,” the researchers wrote. “Men with low-volume nodal disease in the presence of intermediate- to high-grade, non-specimen–confined disease and those with intermediate-volume nodal disease represent the ideal candidates for adjuvant radiotherapy after surgery.”
Disclosure: The researchers report no relevant financial disclosures.
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