TY - JOUR
T1 - Prediction of outcome following early salvage radiotherapy among patients with biochemical recurrence after radical prostatectomy
AU - Briganti, Alberto
AU - Karnes, R. Jeffrey
AU - Joniau, Steven
AU - Boorjian, Stephen A.
AU - Cozzarini, Cesare
AU - Gandaglia, Giorgio
AU - Hinkelbein, Wolfgang
AU - Haustermans, Karin
AU - Tombal, Bertrand
AU - Shariat, Shahrokh
AU - Sun, Maxine
AU - Karakiewicz, Pierre I.
AU - Montorsi, Francesco
AU - Van Poppel, Hein
AU - Wiegel, Thomas
PY - 2014/9
Y1 - 2014/9
N2 - Background Early salvage radiotherapy (eSRT) represents the only curative option for prostate cancer patients experiencing biochemical recurrence (BCR) for local recurrence after radical prostatectomy (RP). Objective To develop and internally validate a novel nomogram predicting BCR after eSRT in patients treated with RP. Design, setting, and participants Using a multi-institutional cohort, 472 node-negative patients who experienced BCR after RP were identified. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at prostate-specific antigen (PSA) ≤0.5 ng/ml. Outcome measurement and statistical analysis BCR after eSRT was defined as two consecutive PSA values ≥0.2 ng/ml. Uni- and multivariable Cox regression models predicting BCR after eSRT were fitted. Regression-based coefficients were used to develop a nomogram predicting the risk of 5-yr BCR after eSRT. The discrimination of the nomogram was quantified with the Harrell concordance index and the calibration plot method. Two hundred bootstrap resamples were used for internal validation. Results and limitations Mean follow-up was 58 mo (median: 48 mo). Overall, 5-yr BCR-free survival rate after eSRT was 73.4%. In univariable analyses, pathologic stage, Gleason score, and positive surgical margins were associated with the risk of BCR after eSRT (all p ≤ 0.04). These results were confirmed in multivariable analysis, where all the previously mentioned covariates as well as pre-RT PSA were significantly associated with BCR after eSRT (all p ≤ 0.04). A coefficient-based nomogram demonstrated a bootstrap-corrected discrimination of 0.74. Our study is limited by its retrospective nature and use of BCR as an end point. Conclusions eSRT leads to excellent cancer control in patients with BCR for presumed local failure after RP. We developed the first nomogram to predict outcome after eSRT. Our model facilitates risk stratification and patient counselling regarding the use of secondary therapy for individuals experiencing BCR after RP. Patient summary Salvage radiotherapy leads to optimal cancer control in patients who experience recurrence after radical prostatectomy. We developed a novel tool to identify the best candidates for salvage treatment and to allow selection of patients to be considered for additional forms of therapy.
AB - Background Early salvage radiotherapy (eSRT) represents the only curative option for prostate cancer patients experiencing biochemical recurrence (BCR) for local recurrence after radical prostatectomy (RP). Objective To develop and internally validate a novel nomogram predicting BCR after eSRT in patients treated with RP. Design, setting, and participants Using a multi-institutional cohort, 472 node-negative patients who experienced BCR after RP were identified. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at prostate-specific antigen (PSA) ≤0.5 ng/ml. Outcome measurement and statistical analysis BCR after eSRT was defined as two consecutive PSA values ≥0.2 ng/ml. Uni- and multivariable Cox regression models predicting BCR after eSRT were fitted. Regression-based coefficients were used to develop a nomogram predicting the risk of 5-yr BCR after eSRT. The discrimination of the nomogram was quantified with the Harrell concordance index and the calibration plot method. Two hundred bootstrap resamples were used for internal validation. Results and limitations Mean follow-up was 58 mo (median: 48 mo). Overall, 5-yr BCR-free survival rate after eSRT was 73.4%. In univariable analyses, pathologic stage, Gleason score, and positive surgical margins were associated with the risk of BCR after eSRT (all p ≤ 0.04). These results were confirmed in multivariable analysis, where all the previously mentioned covariates as well as pre-RT PSA were significantly associated with BCR after eSRT (all p ≤ 0.04). A coefficient-based nomogram demonstrated a bootstrap-corrected discrimination of 0.74. Our study is limited by its retrospective nature and use of BCR as an end point. Conclusions eSRT leads to excellent cancer control in patients with BCR for presumed local failure after RP. We developed the first nomogram to predict outcome after eSRT. Our model facilitates risk stratification and patient counselling regarding the use of secondary therapy for individuals experiencing BCR after RP. Patient summary Salvage radiotherapy leads to optimal cancer control in patients who experience recurrence after radical prostatectomy. We developed a novel tool to identify the best candidates for salvage treatment and to allow selection of patients to be considered for additional forms of therapy.
KW - Biochemical recurrence
KW - Nomogram
KW - Prostate cancer
KW - Radical prostatectomy
KW - Salvage radiotherapy
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U2 - 10.1016/j.eururo.2013.11.045
DO - 10.1016/j.eururo.2013.11.045
M3 - Article
C2 - 24345725
AN - SCOPUS:84905905679
SN - 0302-2838
VL - 66
SP - 479
EP - 486
JO - European urology
JF - European urology
IS - 3
ER -