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• W3093688630 abstract "For men receiving salvage radiotherapy (SRT) after radical prostatectomy (RP), a simple risk grouping system capable of discriminating men at low, intermediate, and high risk of distant metastasis (DM) is lacking. As such, we sought to validate the performance of the new grade grouping (GG) system and propose a novel prognostic three-tier risk grouping in men receiving SRT without androgen deprivation therapy (ADT). We evaluated men diagnosed with localized, node-negative prostate cancer treated at two large academic centers from 1988-2013 who underwent SRT without ADT after biochemical failure post-RP. We assessed the prognostic value of the GG system (GG1-GG5) with respect to distant metastasis-free survival (DMFS) with multivariable Cox and Fine and Gray competing risk regression adjusting for pre-SRT PSA, surgical margin (SM) status, extracapsular extension (ECE), and seminal vesicle invasion (SVI). We used recursive partitioning on DMFS to guide selection of a three-tier risk grouping. 383 patients met inclusion criteria. Median age at SRT was 63 years (interquartile range [IQR] 58-69). 58% had positive SMs and 16% had SVI. Median time from RP to SRT was 22 months (IQR 11-44). Median follow-up was 6.8 years. 78 patients (20%) developed DM. 54 (14%), 137 (36%), 116 (31%), 34 (9%), and 41 (11%) patients had GG1, GG2, GG3, GG4, and GG5 disease, respectively. GG effectively stratified DM (5-year cumulative incidence; GG1: 2%; GG2: 7%; GG3: 16%; GG4: 26%; GG5: 30%). GG outperformed NCCN Gleason risk groups on univariable Cox regression (C statistic 0.63 vs. 0.58). We then defined 3 risk groups: low (GG1-2 and pre-SRT PSA ≤ 0.30), intermediate (GG1-2 and pre-SRT PSA > 0.30, or GG3-5 and pre-SRT PSA ≤ 0.30), and high (pre-SRT PSA > 0.30 and GG3-5). In multivariable Fine-Gray regression, our three-tier risk grouping stratified patients on DM (intermediate vs. low risk: subdistribution HR 5.7 [95% CI 1.4-23]; high vs low risk: subdistribution HR 17.1 [95% CI 4.3-68]) and showed a C-statistic of 0.68 in univariable Cox regression. Model performance was not substantially improved when including SM status, ECE, or SVI. Ten-year cumulative incidence of DM was 2%, 19%, and 51% for low, intermediate, and high-risk groups, respectively. The GG system effectively stratified patients receiving SRT after RP with respect to DM. We propose a simple three-tier risk grouping combining pre-SRT PSA and GG which demonstrated significant ability to identify men at low, intermediate, and high-risk of developing metastatic disease. Pre-SRT PSA and GG provided the majority of the discriminatory ability in identifying men with differing risks for DM." @default.
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• W3093688630 date "2020-11-01" @default.
• W3093688630 modified "2023-10-16" @default.
• W3093688630 title "Development of a Novel Prognostic Three-tier Risk Group Stratification in Men Receiving Post-Prostatectomy Radiation Therapy Without Androgen Deprivation Therapy" @default.
• W3093688630 doi "https://doi.org/10.1016/j.ijrobp.2020.07.471" @default.
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