Journal article
A Recursive Partitioning Analysis Demonstrating Risk Subsets for 8-Year Biochemical Relapse After Margin-Positive Radical Prostatectomy Without Adjuvant Hormone or Radiation Therapy
Advances in radiation oncology, Vol.6(6), p.100778
11/2021
DOI: 10.1016/j.adro.2021.100778
PMCID: PMC8655410
PMID: 34934861
Abstract
The cohort of patients with locally advanced prostate cancer (PC) and positive surgical margin(s) at radical prostatectomy (RP) who would benefit from salvage or adjuvant treatment is unclear. This study examines the risk of prostate-specific antigen (PSA) relapse in a large population of men with PC after margin-positive RP.
Using a multi-institutional database, patients with clinically localized PC who underwent RP between 2002 and 2010 with recorded follow-up PSA were retrospectively selected. Patients were excluded for pathologic seminal vesicle or lymph node involvement, metastatic disease, pre-RP PSA ≥ 30, or adjuvant (nonsalvage) radiation therapy or hormone therapy. The primary endpoint was biochemical relapse free survival (bRFS), where PSA failure was defined as PSA > 0.10 ng/mL and rising, or at salvage intervention. The Kaplan-Meier method was employed for bRFS estimates; recursive partitioning analysis using cumulative or single maximal margin extent (ME) and Gleason grade (GG) at RP was applied to identify variables associated with bRFS.
At median follow-up of 105 months, 210 patients with positive margins at RP were eligible for analysis, and 89 had experienced PSA relapse. Median age was 61 years (range, 43-76), and median pre-RP PSA 5.8 ng/mL (1.6-26.0). Recursive partitioning analysis yielded 5 discrete risk groups, with the lowest risk group (GG1, ≤ 2 mm ME) demonstrating a bRFS of 92% at 8 years compared with the highest risk group (GG3-5, ≥ 3 mm ME) of 11%.
This retrospective study suggests that it may be possible to risk-stratify patients undergoing margin-positive RP using commonly acquired clinical and pathologic variables. Patients with low-grade tumors and minimally involved margins have a very low recurrence risk and may be able to forego postprostatectomy radiation. Meanwhile, those with higher grade and greater involvement could benefit from adjuvant or early salvage radiation therapy.
Details
- Title: Subtitle
- A Recursive Partitioning Analysis Demonstrating Risk Subsets for 8-Year Biochemical Relapse After Margin-Positive Radical Prostatectomy Without Adjuvant Hormone or Radiation Therapy
- Creators
- Steven N Seyedin - University of California, IrvineJohn M Watkins - Departments of Radiation Oncology and PathologyZachary Mayo - Departments of Radiation Oncology and PathologyAnthony N Snow - University of IowaMichael Laszewski - CHI St. Alexius Hospital, Bismarck, North DakotaJ. Kyle Russo - Ochsner Cancer Center, Baton Rouge, LouisianaSarah L Mott - Holden Comprehensive Cancer Center, Iowa City, IowaChad R Tracy - University of IowaMark C Smith - Departments of Radiation Oncology and PathologyJohn M Buatti - Departments of Radiation Oncology and PathologyJoseph M Caster - Departments of Radiation Oncology and Pathology
- Resource Type
- Journal article
- Publication Details
- Advances in radiation oncology, Vol.6(6), p.100778
- DOI
- 10.1016/j.adro.2021.100778
- PMID
- 34934861
- PMCID
- PMC8655410
- NLM abbreviation
- Adv Radiat Oncol
- ISSN
- 2452-1094
- eISSN
- 2452-1094
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 11/2021
- Academic Unit
- Radiology; Pathology; Orthopedics and Rehabilitation; Radiation Oncology; Urology; Neurosurgery; Otolaryngology
- Record Identifier
- 9984201518902771
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