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Prognostic factors in postoperative radiotherapy for prostate cancer – tertiary center experience

Marcin Miszczyk

Marcin Miszczyk

Gliwice, Poland
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Miszczyk, Marcin
, 
Wojciech Majewski

Wojciech Majewski

Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of OncologyGliwice, Poland
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Majewski, Wojciech
, 
Konrad Stawiski

Konrad Stawiski

Department of Biostatistics and Translational Medicine, Medical University of ŁodźŁódź, Poland
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Stawiski, Konrad
, 
Konrad Rasławski

Konrad Rasławski

Gliwice, Poland
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Rasławski, Konrad
, 
Paweł Rajwa

Paweł Rajwa

Department of Urology, Medical University of SilesiaZabrze, Poland
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Rajwa, Paweł
, 
Iwona Jabłońska

Iwona Jabłońska

Gliwice, Poland
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Jabłońska, Iwona
, 
Łukasz Magrowski

Łukasz Magrowski

Gliwice, Poland
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Magrowski, Łukasz
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Oliwia Masri

Oliwia Masri

Gliwice, Poland
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Masri, Oliwia
, 
Andrzej Paradysz

Andrzej Paradysz

Department of Urology, Medical University of SilesiaZabrze, Poland
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Paradysz, Andrzej
 and 
Leszek Miszczyk

Leszek Miszczyk

Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of OncologyGliwice, Poland
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Miszczyk, Leszek
  
Mar 25, 2021
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Article Category: Research Article
Published Online: Mar 25, 2021
Page range: 203 - 211
Received: Nov 20, 2020
Accepted: Feb 06, 2021
DOI: https://doi.org/10.2478/raon-2021-0017
Keywords
© 2021 Marcin Miszczyk, Wojciech Majewski, Konrad Stawiski, Konrad Rasławski, Paweł Rajwa, Iwona Jabłońska, Łukasz Magrowski, Oliwia Masri, Andrzej Paradysz, Leszek Miszczyk, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Bio chemical control depending on treatment indication.
Bio chemical control depending on treatment indication.

Figure 2

Disease-free survival (DFS) depending on treatment indication.
Disease-free survival (DFS) depending on treatment indication.

Figure 3

Recursive partitioning analysis for disease-free survival (DFS).GGG = Gleason grade group; sRT = salvage RT; RT = radiotherapy
Recursive partitioning analysis for disease-free survival (DFS).GGG = Gleason grade group; sRT = salvage RT; RT = radiotherapy

Figure 4

Nomogram for disease-free survival (DFS).ADT = androgen deprivation therapy; GGG = Gleason grade group; RT = radiotherapy
Nomogram for disease-free survival (DFS).ADT = androgen deprivation therapy; GGG = Gleason grade group; RT = radiotherapy

Univariate and multivariate analysis

Univariate analysisMultivariate analysis
DFSBCDFSBC
Covariate:HR (95% CI)p-valueHR (95% CI)p-valueHR (95% CI)p-valueHR (95% CI)p-value
Age0.99 (0.94, 1.04)0.591.03 (0.99, 1.08)0.140.97 (0.92, 1.02)0.191.02 (0.98, 1.07)0.34
max PSA prior to operation1.03 (0.97, 1.08)0.351.03 (1, 1.07)0.0781.04 (0.97, 1.11)0.251.05 (1.02, 1.08)0.001
max PSA post operation1 (0.96, 1.05)0.911.04 (1.02, 1.05)<.0010.53 (0.28, 1.01)0.0521 (0.99, 1.02)0.65
PSA before radiotherapy1.24 (1.12, 1.37)<.0011.26 (1.17, 1.35)<.0012.17 (1.04, 4.55)0.041.19 (1.03, 1.38)0.017
ADT prior to RT1.42 (0.74, 2.74)0.291.06 (0.64, 1.75)0.821.39 (0.69, 2.77)0.350.82 (0.5, 1.35)0.43
pT3a-b vs. pT2a-c2.57 (1.29, 5.1)0.0071.35 (0.83, 2.19)0.234.29 (1.8, 10.25)0.0011.89 (1.02, 3.5)0.044
pN0 vs pN10.58 (0.16, 2.13)0.420.94 (0.3, 2.99)0.920.82 (0.31, 2.19)0.690.98 (0.56, 1.72)0.95
aRT indication - R10.6 (0.27, 1.31)0.20.36 (0.2, 0.64)<.0010.81 (0.19, 3.52)0.780.21 (0.09, 0.52)0.001
aRT indication - pT3a-b1.45 (0.69, 3.04)0.330.86 (0.48, 1.55)0.620.72 (0.18, 2.89)0.641.04 (0.43, 2.53)0.93
sRT indication - biochemical failure1.31 (0.64, 2.68)0.462.02 (1.17, 3.49)0.0111.95 (0.41, 9.27)0.41.12 (0.52, 2.41)0.77
sRT indication - local failure2.03 (1.06, 3.89)0.0332.36 (1.45, 3.84)0.0012.39 (1.11, 5.15)0.0261.48 (0.77, 2.83)0.24
R1 operation (regardless of RT indication)1.2 (0.61, 2.35)0.590.82 (0.5, 1.32)0.411.52 (0.59, 3.92)0.382.17 (1.23, 3.84)0.007
PSA nadir (per 1ng/ml)1.34 (1.2, 1.5)<.0011.29 (1.19, 1.39)<.0011.16 (0.93, 1.46)0.191.37 (1.28, 1.46)<.001
Gleason Grade Group1.4 (1.09, 1.8)0.0091.15 (0.96, 1.38)0.121.28 (0.95, 1.73)0.11.13 (0.93, 1.38)0.23

Description of the study group

Whole groupaRTsRT
Number of cases236113123
Age*63.6 (59.8-68.4)62.3 (58.8-65.9)65.2 (60.5-70.2)
Time from surgery to RT (months)*6 (3.3-25.8)3.6 (2.9-4.8)24.1 (7.3-48.3)
Indicationn/aR11 56pT32 57BCR3 69LF4 54
Positive surgical margins61.5%100%77.2%39.1%27.8%
Max PSA pre-op* (ng/ml)9.16 (6.81-14.6)8.24 (6.33-11.78)9.37 (7.19-14.79)10.67 (7.3-17)8.8 (6.6-13.3)
Max PSA post-op*5 (ng/ml)0.27 (0.04-1.13)0.035 (<0.008-0.071)0.027 (<0.008-0.104)0.72 (0.38-1.92)1.19 (0.45 – 2.89)
PSA before RT* (ng/ml)0.2 (0.023-0.78)0.015 (<0.008-0.055)0.017 (<0.008-0.077)0.56 (0.29-1.07)1.05 (0.35-2.38)
Gleason Grade Group (post-op):
142.2%47.3%26.3%39.7%57.7%
233.6%38.2%40.4%32.3%23.1%
313.4%9.1%15.8%16.2%11.5%
45.6%1.8%7%7.4%5.8%
55.2%3.6%10.5%4.4%1.9%
TNM (post-op):
pT2a-c61.6%100%0%63.6%84.3%
pT3a17.5%0%50.9%12.1%7.8%
pT3b21%0%49.1%24.2%7.8%
pN15.8%1.8%16.4%1.5%4%
ADT prior to RT37.6%16.4%43.9%42.6%46.3%
RT dose^70 / 71.570 / 70.370 / 70.270 / 71.476 / 74.4
Lymph node irradiation25.8%15%47.8%12.7%23.1%
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