Impact of Adherence to Multidisciplinary Recommendations for Adjuvant Treatment in Radical Prostatectomy Patients With High Risk of Recurrence.

Abstract

INTRODUCTION:

The purpose of this study was to investigate adherence to recommended adjuvant radiotherapy (aRT) in radical prostatectomy (RP) patients with adverse pathologic features and to analyse the outcome of patients who followed or denied this recommendation.

PATIENTS AND METHODS:

We included 1140 consecutive RP patients (2006-2015) with non-organ confined (pT3) prostate cancer and either positive surgical margins (R1) and/or lymph node involvement (pN1) and non-detectable postoperative prostate-specific antigen who received multidisciplinary aRT recommendations. Patients were stratified into adherence versus non-adherence to recommendations. Additionally, subgroups within pathologic criteria (pT3R1N0, pT3R0N1, pT3R1N1) were analyzed. Kaplan-Meier, as well as multivariable Cox regression analyses were used to assess biochemical recurrence (BCR)-free survival, metastasis-free survival, cancer-specific survival, and overall survival.

RESULTS:

Overall, 508 (44.6%) patients were non-adherent. Of those, 273 (53.6%) did not receive any RT, and 235 (46.4%) received salvage RT. At 8 years, BCR-free survival was 57.7 versus 20.1%, metastasis-free survival was 76.5 versus 75.4%, cancer-specific survival was 91.7 versus 87.4%, and overall survival was 80.4 versus 75.8% in adherent versus non-adherent patients, respectively (P < .001). In multivariable Cox regression predicting BCR, metastatic progression, cancer-specific mortality, and overall mortality, non-adherence to aRT recommendation represented an independent predictor (hazard ratio [HR], 3.8; 95% confidence interval [CI], 3.1-4.5; HR, 1.6; 95% CI, 1.2-2.2; HR, 2.8; 95% CI, 1.5-5.3; and HR, 1.8; 95% CI, 1.2-2.8, respectively).

CONCLUSIONS:

Only about 55% of patients followed our multidisciplinary recommendations. Adherent patients were significantly less likely to experience BCR, metastatic progression, cancer-specific mortality, and overall mortality. Thus, patients with high risk of recurrence may be advised about the possibility of improved oncologic outcomes in case of adherence to aRT recommendations.

• Authors: Sophie Knipper, Maryam Sadat-Khonsari, Katharina Boehm, Philipp Mandel, Lars Budäus, Thomas Steuber, Tobias Maurer, Hans Heinzer, Rudolf Schwarz, Guido Sauter, Derya Tilki, Hartwig Huland, Markus Graefen
• Journal: Clinical genitourinary cancer (Clin Genitourin Cancer) Vol. 18 Issue 2 Pg. e112-e121 (04 2020) ISSN: 1938-0682 [Electronic] United States
• PMID: 31648965 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• KLK3 protein, human
• Kallikreins
• Prostate-Specific Antigen

Topics

• Aged
• Disease-Free Survival
• Follow-Up Studies
• Humans
• Kallikreins (blood)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Neoplasm Recurrence, Local (blood, diagnosis, epidemiology, prevention & control)
• Patient Compliance (statistics & numerical data)
• Proportional Hazards Models
• Prostate (pathology, surgery)
• Prostate-Specific Antigen (blood)
• Prostatectomy
• Prostatic Neoplasms (blood, mortality, pathology, therapy)
• Radiotherapy, Adjuvant (statistics & numerical data)
• Risk Factors
• Salvage Therapy (methods, statistics & numerical data)