Unification of favourable intermediate-, unfavourable intermediate-, and very high-risk stratification criteria for prostate cancer Journal Article
| Authors: | Zumsteg, Z. S.; Zelefsky, M. J.; Woo, K. M.; Spratt, D. E.; Kollmeier, M. A.; McBride, S.; Pei, X.; Sandler, H. M.; Zhang, Z. |
| Article Title: | Unification of favourable intermediate-, unfavourable intermediate-, and very high-risk stratification criteria for prostate cancer |
| 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. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd |
| Keywords: | adult; aged; major clinical study; overall survival; cancer risk; cancer staging; prostate specific antigen; cohort analysis; tumor biopsy; retrospective study; cancer mortality; distant metastasis; risk assessment; prostate cancer; gleason score; prostate biopsy; prognostic factors; risk stratification; external beam radiotherapy; high risk population; intermediate risk; recurrence free survival; high risk; cancer prognosis; distant metastasis free survival; human; male; priority journal; article; intermediate risk population; very high risk |
| Journal Title: | BJU International |
| Volume: | 120 |
| Issue: | 5B |
| ISSN: | 1464-4096 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2017-11-01 |
| Start Page: | E87 |
| End Page: | E95 |
| Language: | English |
| DOI: | 10.1111/bju.13903 |
| PROVIDER: | scopus |
| PUBMED: | 28464446 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2017 -- Source: Scopus |
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