Outcomes and prognostic factors in intermediate-risk prostate cancer:: multi-institutional analysis of the Spanish RECAP database

• A. Hervás ^[1] ; J. Pastor ^[4] ; C. González ^[3] ; J. Jové ^[5] ; A. Gómez ^[6] ; M. Casaña ^[7] ; E. Villafranca ^[8] ; J. L. Mengual ^[7] ; V. Muñoz ^[9] ; I. Henriquez ^[10] ; J. Muñoz ^[11] ; E. Collado ^[12] ; J. Clemente ^[2]
  1. [1] Hospital Ramón y CajalMadridSpain
  2. [2] Instituto Valenciano de OncologiaAlcoySpain
  3. [3] Hospital Gregorio MarañónMadridSpain
  4. [4] Hospital General de ValenciaValenciaSpain
  5. [5] Hospital Germans Trias i PujolBarcelonaSpain
  6. [6] Hospital Clínico UniversitarioSantiago de CompostelaSpain
  7. [7] Instituto Valenciano de OncologiaValenciaSpain
  8. [8] Hospital Clínico UniversitarioPamplonaSpain
  9. [9] Hospital do MixoeiroVigoSpain
  10. [10] Hospital Universitario Sant JoanReusSpain
  11. [11] Hospital Infanta CristinaBadajozSpain
  12. [12] Hospital Uiversitario La FeValenciaSpain

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 21, Nº. 7, 2019, págs. 900-909
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Purpose To retrospectively assess outcomes and to identify prognostic factors in patients diagnosed with intermediate-risk (IR) prostate cancer (PCa) treated with primary external beam radiotherapy (EBRT).

    Materials and methods Data were obtained from the multi-institutional Spanish RECAP database, a population-based prostate cancer registry in Spain. All IR patients (NCCN criteria) who underwent primary EBRT were included. The following variables were assessed: age; prostate-specific antigen (PSA); Gleason score; clinical T stage; percentage of positive biopsy cores (PPBC); androgen deprivation therapy (ADT); and radiotherapy dose. The patients were stratified into one of three risk subcategories: (1) favourable IR (FIR; GS 6, ≤ T2b or GS 3 + 4, ≤ T1c), (2) marginal IR (MIR; GS 3 + 4, T2a–b), and (3) unfavourable IR (UIR; GS 4 + 3 or T2c). Biochemical relapse-free survival (BRFS), disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) were assessed.

    Results A total of 1754 patients from the RECAP database were included and stratified by risk group: FIR, n = 781 (44.5%); MIR, n = 252 (14.4%); and UIR, n = 721 (41.1%). Mean age was 71 years (range 47–86). Mean PSA was 10.4 ng/ml (range 6–20). The median radiotherapy dose was 74 Gy, with mean doses of 72.5 Gy (FIR), 73.4 Gy (MIR), and 72.8 Gy (UIR). Most patients (88%) received ADT for a median of 7.1 months. By risk group (FIR, MIR, UIR), ADT rates were, respectively, 88.9, 86.5, and 86.9%. Only patients with ≥ 24 months of follow-up post-EBRT were included in the survival analysis (n = 1294). At a median follow-up of 52 months (range 24–173), respective 5- and 10-year outcomes were: OS 93.6% and 79%; BRFS 88.9% and 71.4%; DFS 96.1% and 89%; CSS 98.9% and 94.6%. Complication rates (≥ grade 3) were: acute genitourinary (GU) 2%; late GU 1%; acute gastrointestinal (GI) 2%; late GI 1%. There was no significant association between risk group and BRFS or OS. However, patients with favourable-risk disease had significantly better 5- and 10-year DFS than patients with UIR: 98.7% vs. 92.4% and 92% vs. 85.8% (p = 0.0005). CSS was significantly higher (p = 0.0057) in the FIR group at 5 (99.7% vs. 97.3%) and 10 years (96.1% vs. 93.4%). On the multivariate analyses, the following were significant predictors of survival: ADT (BRFS and DFS); dose ≥ 74 Gy (BRFS); age (OS).

    Conclusions This is the first nationwide study in Spain to report long-term outcomes of patients with intermediate-risk PCa treated with EBRT. Survival outcomes were good, with a low incidence of both acute and late toxicity. Patients with unfavourable risk characteristics had significantly lower 5- and 10-year disease-free survival rates. ADT and radiotherapy dose ≥ 74 Gy were both significant predictors of treatment outcomes.