Ten-year disease progression and mortality rates in men who experience biochemical recurrence versus persistence after radical prostatectomy and undergo salvage radiation therapy: A post-hoc analysis of RTOG 9601 trial data.
Urol Oncol
; 38(6): 599.e1-599.e8, 2020 06.
Article
de En
| MEDLINE
| ID: mdl-32229186
ABSTRACT
PURPOSE:
To compare local/metastatic disease progression and overall mortality rates in men with node-negative prostate cancer at radical prostatectomy (RP) that experience biochemical recurrence vs. persistence postoperatively and undergo salvage radiation therapy (sRT). MATERIALS ANDMETHODS:
Data on 760 men who participated in the RTOG 9601 trial were extracted using the NCTN data archive platform. Patients were stratified into biochemical recurrence (nadir-PSA ≤0.4 ng/ml) or persistence (nadir-PSA >0.4 ng/ml) groups, based on the cut-off reported in the original trial. Inverse probability of treatment weighting (IPTW) methodology was utilized to minimize the baseline differences among groups. Competing-risk and Kaplan-Meier analyses estimated the impact of prostate-specific antigen (PSA) persistence vs. recurrence on local and metastatic disease progression and overall-mortality in the IPTW-adjusted model; a 2-sided P < 0.05 was considered significant.RESULTS:
All patients received sRT, and about 50% of the patients in either group received concomitant antiandrogen therapy (Pâ¯=â¯0.951). The median follow-up was 12 years. After IPTW, the 2 groups were well-matched with standardized mean differences â¼10%. In the IPTW-adjusted cohort, the 10-year local and metastatic disease occurrence rates were 3.2% vs. 1.4% (Gray's Pâ¯=â¯0.0001) and 28.6% vs. 10.1% (Gray's P < 0.0001) in patients with persistent vs. recurrent PSA, respectively. Similarly, the 10-year overall-mortality rates were 24.9% vs. 11.9% (Log-rank Pâ¯=â¯0.029), respectively.CONCLUSIONS:
Patients with biochemical persistence after RP are approximately 2.5 times more likely to experience local/metastatic failure and death, compared to patients with biochemical recurrence after RP, despite equivalent sRT with/without antiandrogen therapy use. These data may facilitate patient counseling and shared treatment selection.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Prostatectomie
/
Tumeurs de la prostate
/
Antigène spécifique de la prostate
/
Récidive tumorale locale
Type d'étude:
Prognostic_studies
Limites:
Aged
/
Humans
/
Male
/
Middle aged
Langue:
En
Journal:
Urol Oncol
Sujet du journal:
NEOPLASIAS
/
UROLOGIA
Année:
2020
Type de document:
Article