Zachary S Zumsteg1,2, Michael J Zelefsky1, Kaitlin M Woo1, Daniel E Spratt1,3, Marisa A Kollmeier1, Sean McBride1, Xin Pei1, Howard M Sandler2, Zhigang Zhang4. 1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 2. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 3. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA. 4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
OBJECTIVE: To improve on the existing risk-stratification systems for prostate cancer. PATIENTS AND METHODS: This was a retrospective investigation including 2 248 patients undergoing dose-escalated external beam radiotherapy (EBRT) at a single institution. We separated National Comprehensive Cancer Network (NCCN) intermediate-risk prostate cancer into 'favourable' and 'unfavourable' groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), and number of NCCN intermediate-risk factors. Similarly, NCCN high-risk prostate cancer was stratified into 'standard' and 'very high-risk' groups based on primary Gleason pattern, PPBC, number of NCCN high-risk factors, and stage T3b-T4 disease. Patients with unfavourable-intermediate-risk (UIR) prostate cancer had significantly inferior prostate-specific antigen relapse-free survival (PSA-RFS, P < 0.001), distant metastasis-free survival (DMFS, P < 0.001), prostate cancer-specific mortality (PCSM, P < 0.001), and overall survival (OS, P < 0.001) compared with patients with favourable-intermediate-risk (FIR) prostate cancer. Similarly, patients with very high-risk (VHR) prostate cancer had significantly worse PSA-RFS (P < 0.001), DMFS (P < 0.001), and PCSM (P = 0.001) compared with patients with standard high-risk (SHR) prostate cancer. Moreover, patients with FIR and low-risk prostate cancer had similar outcomes, as did patients with UIR and SHR prostate cancer. RESULTS: Consequently, we propose the following risk-stratification system: Group 1, low risk and FIR; Group 2, UIR and SHR; and Group 3, VHR. These groups have markedly different outcomes, with 8-year distant metastasis rates of 3%, 9%, and 29% (P < 0.001) for Groups 1, 2, and 3, respectively, and 8-year PCSM of 1%, 4%, and 13% (P < 0.001) after EBRT. This modified stratification system was significantly more accurate than the three-tiered NCCN system currently in clinical use for all outcomes. CONCLUSION: Modifying the NCCN risk-stratification system to group FIR with low-risk patients and UIR with SHR patients, results in modestly improved prediction of outcomes, potentially allowing better personalisation of therapeutic recommendations.
OBJECTIVE: To improve on the existing risk-stratification systems for prostate cancer. PATIENTS AND METHODS: This was a retrospective investigation including 2 248 patients undergoing dose-escalated external beam radiotherapy (EBRT) at a single institution. We separated National Comprehensive Cancer Network (NCCN) intermediate-risk prostate cancer into 'favourable' and 'unfavourable' groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), and number of NCCN intermediate-risk factors. Similarly, NCCN high-risk prostate cancer was stratified into 'standard' and 'very high-risk' groups based on primary Gleason pattern, PPBC, number of NCCN high-risk factors, and stage T3b-T4 disease. Patients with unfavourable-intermediate-risk (UIR) prostate cancer had significantly inferior prostate-specific antigen relapse-free survival (PSA-RFS, P < 0.001), distant metastasis-free survival (DMFS, P < 0.001), prostate cancer-specific mortality (PCSM, P < 0.001), and overall survival (OS, P < 0.001) compared with patients with favourable-intermediate-risk (FIR) prostate cancer. Similarly, patients with very high-risk (VHR) prostate cancer had significantly worse PSA-RFS (P < 0.001), DMFS (P < 0.001), and PCSM (P = 0.001) compared with patients with standard high-risk (SHR) prostate cancer. Moreover, patients with FIR and low-risk prostate cancer had similar outcomes, as did patients with UIR and SHR prostate cancer. RESULTS: Consequently, we propose the following risk-stratification system: Group 1, low risk and FIR; Group 2, UIR and SHR; and Group 3, VHR. These groups have markedly different outcomes, with 8-year distant metastasis rates of 3%, 9%, and 29% (P < 0.001) for Groups 1, 2, and 3, respectively, and 8-year PCSM of 1%, 4%, and 13% (P < 0.001) after EBRT. This modified stratification system was significantly more accurate than the three-tiered NCCN system currently in clinical use for all outcomes. CONCLUSION: Modifying the NCCN risk-stratification system to group FIR with low-risk patients and UIR with SHR patients, results in modestly improved prediction of outcomes, potentially allowing better personalisation of therapeutic recommendations.
Authors: Mira A Patel; Marisa Kollmeier; Sean McBride; Daniel Gorovets; Melissa Varghese; Luanna Chan; Andrea Knezevic; Zhigang Zhang; Michael J Zelefsky Journal: Radiother Oncol Date: 2019-06-06 Impact factor: 6.280
Authors: Kevin Shee; Claire M de la Calle; Albert J Chang; Anthony C Wong; Felix Y Feng; Alexander R Gottschalk; Peter R Carroll; Hao G Nguyen Journal: Adv Radiat Oncol Date: 2022-03-12
Authors: Zachary S Zumsteg; Zinan Chen; Lauren E Howard; Christopher L Amling; William J Aronson; Matthew R Cooperberg; Christopher J Kane; Martha K Terris; Daniel E Spratt; Howard M Sandler; Stephen J Freedland Journal: Prostate Date: 2017-10-10 Impact factor: 4.104
Authors: Jae Won Park; Dong Hoon Koh; Won Sik Jang; Joo Yong Lee; Kang Su Cho; Won Sik Ham; Koon Ho Rha; Woo Hee Jung; Sung Joon Hong; Young Deuk Choi Journal: PLoS One Date: 2018-06-20 Impact factor: 3.240
Authors: Silvia Rodríguez Villalba; Paula Monasor Denia; Maria Jose Pérez-Calatayud; Jose Richart Sancho; Jose Pérez-Calatayud; Antonio Fuster Escrivá; Pedro Torrus Tendero; Manuel Santos Ortega Journal: J Contemp Brachytherapy Date: 2021-04-14
Authors: Maurizio Valeriani; Mario Di Staso; Giuseppe Facondo; Gianluca Vullo; Vitaliana De Sanctis; Giovanni Luca Gravina; Milena di Genesio Pagliuca; Mattia Falchetto Osti; Pierluigi Bonfili Journal: J Clin Med Date: 2022-08-16 Impact factor: 4.964
Authors: Robert T Dess; Krithika Suresh; Michael J Zelefsky; Stephen J Freedland; Brandon A Mahal; Matthew R Cooperberg; Brian J Davis; Eric M Horwitz; Martha K Terris; Christopher L Amling; William J Aronson; Christopher J Kane; William C Jackson; Jason W D Hearn; Curtiland Deville; Theodore L DeWeese; Stephen Greco; Todd R McNutt; Daniel Y Song; Yilun Sun; Rohit Mehra; Samuel D Kaffenberger; Todd M Morgan; Paul L Nguyen; Felix Y Feng; Vidit Sharma; Phuoc T Tran; Bradley J Stish; Thomas M Pisansky; Nicholas G Zaorsky; Fabio Ynoe Moraes; Alejandro Berlin; Antonio Finelli; Nicola Fossati; Giorgio Gandaglia; Alberto Briganti; Peter R Carroll; R Jeffrey Karnes; Michael W Kattan; Matthew J Schipper; Daniel E Spratt Journal: JAMA Oncol Date: 2020-12-01 Impact factor: 31.777