Sophie Knipper1, Pierre I Karakiewicz2, Alexander Heinze3, Felix Preisser4, Thomas Steuber5, Hartwig Huland3, Markus Graefen3, Derya Tilki5. 1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada. Electronic address: a.knipper@uke.de. 2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada. 3. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. 5. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: To examine the impact of different pretreatment definitions on biochemical recurrence (BCR)-free survival, metastasis-free survival, and cancer-specific survival after radical prostatectomy. METHODS: Overall, 26,364 patients with clinically localized disease who underwent radical prostatectomy at a single institution (1992-2017) were retrospectively analyzed. Seven pretreatment definitions of high-risk CaP (prostate-specific antigen [PSA] ≥20 ng/ml, clinical stage ≥T2c, clinical stage T3 [cT3], biopsy Gleason score [GS] 8-10 [Grade Group {GG} IV-V], biopsy GS 9 to 10 [GG V], D'Amico risk definition, National Comprehensive Cancer Network risk definition) were evaluated. Kaplan-Meier, as well as multivariable Cox regression analyses were used. RESULTS: Depending on the definition, patients with high-risk CaP comprised between 0.9% (cT3) and 20.3% (D'Amico high-risk) of the population. Ten-year BCR-free survival rates varied from 36.0% (≥cT2c) to 47.4% (National Comprehensive Cancer Network high-risk). Ten-year metastasis-free survival rates varied from 56.6% (GS 9-10/GG V) to 77.5% (PSA ≥ 20 ng/ml). Ten-year cancer-specific survival rates varied from 86.6% (cT3) to 94.5% (PSA ≥ 20 ng/ml). In multivariable analysis, all high-risk definitions were associated with significantly higher risk of BCR (hazard ratio [HR]: 3.4-3.9), metastatic progression (HR: 3.9-8.8), and cancer-specific mortality (HR: 2.8-11.2). CONCLUSIONS: Variety in outcomes exists, depending on the pretreatment definition of high-risk CaP. Among the tested, GS 9 to 10 (GG V), cT2c, and cT3 were the strongest predictor for higher BCR risk, cT3 was the strongest predictor for higher metastatic progression risk and GS 9 to 10 (GG V) was the strongest predictor for higher cancer-specific mortality risk in multivariable analyses.
BACKGROUND: To examine the impact of different pretreatment definitions on biochemical recurrence (BCR)-free survival, metastasis-free survival, and cancer-specific survival after radical prostatectomy. METHODS: Overall, 26,364 patients with clinically localized disease who underwent radical prostatectomy at a single institution (1992-2017) were retrospectively analyzed. Seven pretreatment definitions of high-risk CaP (prostate-specific antigen [PSA] ≥20 ng/ml, clinical stage ≥T2c, clinical stage T3 [cT3], biopsy Gleason score [GS] 8-10 [Grade Group {GG} IV-V], biopsy GS 9 to 10 [GG V], D'Amico risk definition, National Comprehensive Cancer Network risk definition) were evaluated. Kaplan-Meier, as well as multivariable Cox regression analyses were used. RESULTS: Depending on the definition, patients with high-risk CaP comprised between 0.9% (cT3) and 20.3% (D'Amico high-risk) of the population. Ten-year BCR-free survival rates varied from 36.0% (≥cT2c) to 47.4% (National Comprehensive Cancer Network high-risk). Ten-year metastasis-free survival rates varied from 56.6% (GS 9-10/GG V) to 77.5% (PSA ≥ 20 ng/ml). Ten-year cancer-specific survival rates varied from 86.6% (cT3) to 94.5% (PSA ≥ 20 ng/ml). In multivariable analysis, all high-risk definitions were associated with significantly higher risk of BCR (hazard ratio [HR]: 3.4-3.9), metastatic progression (HR: 3.9-8.8), and cancer-specific mortality (HR: 2.8-11.2). CONCLUSIONS: Variety in outcomes exists, depending on the pretreatment definition of high-risk CaP. Among the tested, GS 9 to 10 (GG V), cT2c, and cT3 were the strongest predictor for higher BCR risk, cT3 was the strongest predictor for higher metastatic progression risk and GS 9 to 10 (GG V) was the strongest predictor for higher cancer-specific mortality risk in multivariable analyses.
Authors: Amar U Kishan; R Jeffrey Karnes; Tahmineh Romero; Jessica K Wong; Giovanni Motterle; Jeffrey J Tosoian; Bruce J Trock; Eric A Klein; Bradley J Stish; Robert T Dess; Daniel E Spratt; Avinash Pilar; Chandana Reddy; Rebecca Levin-Epstein; Trude B Wedde; Wolfgang A Lilleby; Ryan Fiano; Gregory S Merrick; Richard G Stock; D Jeffrey Demanes; Brian J Moran; Michelle Braccioforte; Hartwig Huland; Phuoc T Tran; Santiago Martin; Rafael Martínez-Monge; Daniel J Krauss; Eyad I Abu-Isa; Ridwan Alam; Zeyad Schwen; Albert J Chang; Thomas M Pisansky; Richard Choo; Daniel Y Song; Stephen Greco; Curtiland Deville; Todd McNutt; Theodore L DeWeese; Ashley E Ross; Jay P Ciezki; Paul C Boutros; Nicholas G Nickols; Prashant Bhat; David Shabsovich; Jesus E Juarez; Natalie Chong; Patrick A Kupelian; Anthony V D'Amico; Matthew B Rettig; Alejandro Berlin; Jonathan D Tward; Brian J Davis; Robert E Reiter; Michael L Steinberg; David Elashoff; Eric M Horwitz; Rahul D Tendulkar; Derya Tilki Journal: JAMA Netw Open Date: 2021-07-01