Prognostic impact of regional lymph node metastasis at castration-resistant prostate cancer diagnosis on survival after radium-223 treatment
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Radium-223 (Ra-223) is used for patients with bone-metastatic castration-resistant prostate cancer (CRPC). However, the prognostic value of regional lymph node metastasis at CRPC diagnosis for survival after Ra-223 remains unclear. This study evaluated the association between regional lymph node metastasis at CRPC diagnosis and overall survival (OS) after Ra-223 initiation. METHODS: This multicenter retrospective cohort study used the Following Ra-223 in Outcomes after New-generation Therapy with Investigation of Effects in Refractory prostate cancer study database. Patients with bone-metastatic CRPC who initiated Ra-223 between January 2020 and December 2023 were included. Patients were classified according to the presence or absence of regional lymph node metastasis at CRPC diagnosis. The primary endpoint was OS from Ra-223 initiation. Cox proportional hazards regression was used to evaluate the association between regional lymph node metastasis and OS. RESULTS: Among 802 patients who initiated Ra-223, 718 were included: 505 without regional lymph node metastasis and 213 with regional lymph node metastasis at CRPC diagnosis. Median OS was 31 months (95% confidence interval [CI], 26-35) and 17 months (95% CI, 16-22), respectively (log-rank P < 0.001). In multivariable analysis, regional lymph node metastasis at CRPC diagnosis was associated with poorer OS (hazard ratio, 1.396; 95% CI, 1.092-1.785; P = 0.008). CONCLUSIONS: Regional lymph node metastasis at CRPC diagnosis was associated with poorer OS after Ra-223 initiation. This status may provide prognostic information when considering subsequent treatment sequencing in bone-metastatic CRPC.
DOI: 10.1093/jjco/hyag125
Authors: Saizo Fujimoto, Takuma Kato, Masatoshi Eto, Mototaka Sato, Takahito Negishi, Akinori Wada, Tadamasa Shibuya, Jun Akatsuka, Shuichi Morizane, Tatsuya Takayama, Akira Tsujimura, Hiroki Kitou, Hiromasa Tsukino, Yoshihiro Matsunaga, Kazutoshi Fujita, for the FRONTIER Study Group, Akinori Wada, Akira Tsujimura, Atsushi Kyan, Atsushi Mizokami, Dai Koguchi, Fumio Ishizaki, Fumio Tsukuda, Hirofumi Izaki, Hirofumi Morinaka, Hiroki Kitou, Hiromasa Tsukino, Hiroshi Kitamura, Hisanori Taniguchi, Jun Akatsuka, Junichi Inokuchi, Junya Furukawa, Katsuyoshi Hashine, Kazutoshi Fujita, Kohei Hasimoto, Koichiro Wada, Koji Shiraishi, Kazuki Kokura, Eiji Matsubara, Masashi Kato, Masashi Morita, Masatoshi Eto, Masaya Ito, Masayoshi Nagata, Masayuki Hagiwara, Minato Yokoyama, Mitsuru Noguchi, Naoki Fujita, Naoki Terada, Nobuhiro Haga, Norihiko Kawamura, Norihiko Tsuchiya, Norio Nonomura, Mototaka Sato, Osamu Ukimura, Rei Unno, Ryoichi Imamura, Ryoma Kurahashi, Ryuji Matsumoto, Ryuto Nakazawa, Sadanori Kamikawa, Sayuri Takahashi, Seiji Hoshi, Shingo Sugaya, Shinichi Sakamoto, Shinsuke Kurokawa, Hiromi Sato, Shuichi Tatarano, Soichi Makino, Shuichi Morizane, Tadamasa Shibuya, Takahito Negishi, Takanori Mochizuki, Takashi Fukagai, Takashi Kawahara, Takashi Kobayashi, Takashi Saika, Tatsuya Takayama, Toru Harabayashi, Toshiaki Shinojima, Toshitaka Shin, Atsuro Sawada, Tsutomu Nishiyama, Yasuo Kohjimoto, Yasushi Nakai, Yoshihiro Hasegawa, Yoshihiro Matsunaga, Yoshiyuki Miyazawa, Yujiro Nagata, Yuki Yamada, Yukio Naya, Yusuke Ito, Yutaka Yamamoto
Institutions: Kindai University, Kagawa University, Kagawa University Hospital, Kyushu University, Toyonaka Municipal Hospital, National Hospital Organization Kyushu Cancer Center, Shiga University of Medical Science, Oita Red Cross Hospital, Nippon Medical School, Tottori University, International University of Health and Welfare, Juntendo University Urayasu Hospital, Japan Community Healthcare Organization, Tokyo Shinjuku Medical Center, Kurume University
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $3,604
OpenAlex ID: W7201833690