Effect of Radical Prostatectomy on Survival for Men with High-risk Nonmetastatic Prostate Cancer Features Selected According to STAMPEDE Criteria: An EMPaCT Study.

Autor: Milonas D; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology, Lithuanian University of Health Sciences, Kaunas, Lithuania., Giesen A; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium., Laenen A; KU Leuven Biostatistics and Statistical Bioinformatics Center, Leuven, Belgium., Devos G; Department of Urology, University Hospitals Leuven, Leuven, Belgium., Briganti A; Department of Urology, University Vita Salute, San Raffaele Hospital, Milan, Italy., Gontero P; Department of Urology, University of Turin, A.O.U. San Giovanni Battista-le Molinette, Turin, Italy., Karnes RJ; Department of Urology, Mayo Clinic, Rochester, MN, USA., Chlosta P; Department of Urology, Jagiellonian University Medical College, Krakow, Poland., Claessens F; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium., De Meerleer G; Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium., Everaerts W; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium., Graefen M; Martini Klinik am UKE GmbH, Hamburg, Germany., Marchioro G; Department of Urology, University of Piemonte Orientale, Novara, Italy., Sanchez-Salas R; Department of Urology, McGill University, Montreal, Canada., Tombal B; Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium., Van Der Poel H; Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Van Poppel H; Department of Urology, University Hospitals Leuven, Leuven, Belgium., Spahn M; Department of Urology, Lindenhofspital Bern, Bern, Switzerland., Joniau S; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium. Electronic address: steven.joniau@uzleuven.be.
Jazyk: angličtina
Zdroj: European urology oncology [Eur Urol Oncol] 2024 Jul 11. Date of Electronic Publication: 2024 Jul 11.
DOI: 10.1016/j.euo.2024.05.016
Abstrakt: Background and Objective: A meta-analysis of two randomized STAMPEDE platform trials revealed that 3 yr of abiraterone acetate in addition to androgen deprivation therapy and radiation therapy significantly improved metastasis-free and overall survival (OS) in high-risk nonmetastatic prostate cancer (PCa) and should be considered a new standard of care. The aim of our study was to assess long-term cancer-specific survival (CSS) and OS for surgically treated patients with newly diagnosed nonmetastatic node-negative PCa meeting the STAMPEDE criteria for high risk.
Methods: This was a retrospective, multicenter cohort study of patients with European Association of Urology (EAU) high-risk PCa who underwent radical prostatectomy and extended pelvic lymph node dissection. CSS was assessed using cumulative incidence curves and the Kaplan-Meier method was used to evaluate OS. We used a Fine and Gray model to evaluate the prognostic value of STAMPEDE high-risk factors (SHRFs) for CSS, and a Cox proportional-hazards model to assess the association of SHRFs with OS.
Key Findings and Limitations: A total of 2994 patients with EAU high-risk PCa were divided into groups with 0, 1, 2, or 3 SHRFs. The 10-yr survival estimates for patients with 0-1 versus 2-3 SHRFs were 95% versus 82% for CSS and 81% versus 64% for OS (both p < 0.0001). In comparison to patients with 0 SHRFs, hazard ratios were 1.2 (p = 0.5), 3.9 (p < 0.0001), and 5.5 (p < 0.0001) for CSS, and 1.1 (p = 0.4), 2.2 (p < 0.0001), and 2.5 (p = 0.0004) for OS for patients with 1, 2, and 3 SHRFs, respectively.
Conclusions and Clinical Implications: Our results confirm that the STAMPEDE high-risk criteria identify a subgroup of patients with highly aggressive PCa features and adverse long-term oncological outcomes. This population is likely to benefit most from aggressive multimodal treatment. Nevertheless, we have shown for the first time that surgery remains a viable treatment option for patients with STAMPEDE high-risk PCa.
Patient Summary: Prostate cancer that meets the high-risk definitions from the STAMPEDE trial is an aggressive type of cancer. Our results for long-term cancer control outcomes indicate that surgery is a viable option for the subgroup of patients with this type of prostate cancer.
(Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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