Long-term outcomes of radiotherapy and impact of nodal disease burden in clinically node-positive prostate cancer
Notice bibliographique
Résumé
PURPOSE: The optimal management for pelvic clinical node-positive (cN1) prostate cancer remains controversial and randomized evidence for local therapy is lacking. Recent data suggest that common-iliac nodal metastases might carry a prognosis similar to that of cN1 disease when treated radically. In this context, we retrospectively reviewed the experience at our centre of treating cN1 prostate cancer, with or without common-iliac nodal metastases, focusing on the role of radiotherapy and the effect of nodal disease burden on survival. MATERIALS AND METHODS: The study population consisted of men diagnosed with prostate cancer between 2002 and 2018 with cN1 disease and/or common-iliac nodal metastases and treated with androgen deprivation therapy and/or definitive local therapy. Outcomes of interest included overall survival and castration resistance-free survival, which were estimated using the Kaplan-Meier method. Univariable and multivariable Cox regression were used to identify factors associated with overall - and castration resistance-free survival. In the subgroup of patients treated with radiation, the association between a number of variables - including biologically effective dose to the prostate, use of elective pelvic nodal radiotherapy, and escalated dose (radiotherapy boost) to positive nodes-and overall survival was studied. RESULTS: A total of 87 patients were included, of whom 14 had common-iliac nodal metastases and 68 received radiotherapy. Median follow-up was 110 months. On univariate analysis, radiotherapy was associated with improved overall survival (hazard ratio [HR]: 0.28, 95 % confidence interval [CI]: 0.14-0.55, P<0.0005) and castration resistance-free survival (HR: 0.22, 95 % CI: 0.12-0.41, P<0.0005). Median overall survival in those patients receiving radiotherapy was 134.9 versus 63.1 months in those not receiving radiotherapy. Receipt of radiotherapy remained significantly associated with overall survival on multivariable analysis (HR: 0.13, 95 % CI: 0.05-0.32, P<0.001). Biopsy Gleason score 10 and presence of more than two positive lymph nodes were associated with worse overall survival while presence of common-iliac nodal metastases was not found to have any significant association with overall survival. In patients treated with radiation, increasing the biologically effective dose to the prostate was associated with improved overall survival (HR: 0.73 per 10Gy, 95 % CI: 0.54-0.97, P=0.03) while use of elective pelvic nodal radiotherapy and use of a radiotherapy boost to positive nodes had no significant association with overall survival. CONCLUSION: In this cohort, we evaluate the impact of radiotherapy in pelvic clinical node-positive prostate cancer that includes common-iliac nodal metastases. Receipt of radiotherapy was associated with improved oncologic outcomes. The number of positive pelvic nodes, but not their common-iliac location, was prognostic.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».