Penalized-Survival Nomogram Predicts 5-Year Metastasis-Free Survival After Salvage Radiotherapy for Postprostatectomy Patients: A Multicenter Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND/AIM: Salvage radiotherapy (SRT) is a key treatment for biochemical recurrence (BCR) after radical prostatectomy (RP), yet a significant proportion of patients progress to distant metastasis. This multicenter retrospective study aimed to analyze a series of patients who underwent SRT and to develop a predictive nomogram for 5-year-distant-metastasis-free survival (DMFS). MATERIAL AND METHODS: Data were collected from 15 European centers from June 1, 2022, to September 30, 2024. We included SRT patients due to BCR, following RP and no evidence of distant metastases on imaging. A penalized-survival nomogram was developed and internally validated; external validation was performed using data from the largest center. Patients were stratified into low-, intermediate-, and high-risk groups based on tertiles of the predicted risk score distribution. RESULTS: Data from 1,720 SRT patients were analyzed. BCR after SRT occurred in 620 (37%) patients, while clinical recurrence in 494 (30%) patients. Distant metastases were diagnosed in 228 patients (13%). The 2- and 5- years DMFS rates were 93% (95% CI, 92%-95%) and 84% (95% CI, 81%-86%), respectively. Multivariate analysis identified pT3/pT4 stage (HR 1.54 [95% CI, 1.13-2.13], P < .01), ISUP grade group 4/5 (HR 1.75 [95% CI, 1.30-2.35], P < .01), and SRT <12 months from surgery (HR 1.49 [95% CI, 1.07-2.09], P = .02) as independent predictors of DM. The nomogram achieved a C-index of 0.70 in external validation. Stratification into risk groups showed significant differences in DMFS (P < .01). CONCLUSIONS: This externally validated nomogram provides a practical tool for predicting 5-year DMFS in patients undergoing SRT. It enables personalized risk assessment, guiding intensified surveillance and treatment for high-risk patients.
Source: Clinical Genitourinary Cancer
Authors: F. Mastroleo, R. Villa, M. Zaffaroni, M.G. Vincini, C. Franzese, L. Nicosia, F. Matrone, A. Donofrio, A. Magli, L. Triggiani, S. Barra, G. Timon, M. Augugliaro, V. Burgio, G. Francolini, M. Hasterok, M. Miszczyk, N. Simoni, C. Spatola, F. Alongi, S. Arcangeli, M. Scorsetti, G. Marvaso, B.A. Jereczek-Fossa
Institutions: University of Milan, European Institute of Oncology, Humanitas University, IRCCS Humanitas Research Hospital, Ospedale Sacro Cuore Don Calabria, Centro di Riferimento Oncologico, University of Udine, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, Ospedale Policlinico San Martino, Azienda Sanitaria Unità Locale di Reggio Emilia, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Azienda Ospedaliero-Universitaria Careggi, The Maria Sklodowska-Curie National Research Institute of Oncology, Comprehensive Cancer Center Vienna, WSB University, Medical University of Vienna, University of Parma, University of Catania, University of Milano-Bicocca
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,530
OpenAlex ID: W4413469398