National Cancer Data Base Analysis Indicates Survival Benefit of Adding Radiotherapy to ADT in Clinically Node-Positive Prostate Cancer
In an analysis reported in the Journal of the National Cancer Institute, Lin et al found that the addition of radiotherapy to androgen-deprivation therapy was associated with a significant improvement in overall survival in patients with clinically node-positive prostate cancer.
Study Details
The study included data from the National Cancer Data Base on patients with clinically node-positive cancer without distant metastases diagnosed between 2004 and 2011. Five-year overall survival for patients diagnosed between 2004 and 2006 and treated with androgen-deprivation therapy alone vs androgen-deprivation therapy plus radiotherapy was analyzed.
Characteristics and Survival
Among 3,540 total patients, 1,818 (51.4%) received androgen-deprivation therapy plus radiotherapy and 1,141 (32.2%) received androgen-deprivation therapy alone. Patients treated with androgen-deprivation therapy plus radiotherapy were more likely to be younger (P < .001) and to have private insurance (P < .001), a lower comorbidity score (P = .002), a higher Gleason grade (P < .001), a lower prostate-specific antigen level (P < .001), and clinical T stage T2 or T3 (P < .001). Crude 5-year overall survival was 72.4% in the androgen-deprivation therapy plus radiotherapy group vs 49.4% in the androgen-deprivation therapy group alone (P < .001), with a hazard ratio (HR) of 0.51 (P < .001) favoring androgen-deprivation therapy plus radiotherapy after adjustment for confounding variables.
Propensity Score Matching Analysis
After propensity score matching, 318 patients remained in each group, with no significant differences in matched factors. Crude 5-year overall survival in this analysis was 71.5% with androgen-deprivation therapy plus radiotherapy vs 53.2% with androgen-deprivation therapy alone (P < .001), with a hazard ratio of 0.50 (P < .001) after adjustment for demographic and clinical characteristics.
The investigators concluded, “Using a large national database, we have identified a statistically significant survival benefit for patients with [clinically node-positive prostate cancer] treated with androgen-deprivation therapy + [radiotherapy]. These data, if appropriately validated by randomized trials, suggest that a substantial proportion of such patients at high risk for prostate cancer death may be undertreated, warranting a reevaluation of current practice guidelines.”
Jason A. Efstathiou, MD, DPhil, of Massachusetts General Hospital, is the corresponding author of the Journal of the National Cancer Institute article.
The study was supported by the American Cancer Society and the Prostate Cancer Foundation.
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