Adjuvant radiation with hormonal therapy is associated with improved survival in men with pathologically involved lymph nodes after radical surgery for prostate cancer.
PURPOSE
Recent studies have suggested that the addition of adjuvant radiation therapy (aRT) may improve outcomes in men with pathologically involved lymph nodes (pN+). The objective of this study was to assess the treatment patterns and the overall survival (OS) outcomes in men with pN+prostate cancer using the National Cancer Data Base.


METHODS
Men diagnosed with nonmetastatic prostate cancer between 2004 and 2011, who underwent radical prostatectomy for pN+were identified in the National Cancer Data Base. Patients were stratified into subgroups of those receiving no adjuvant therapy and those receiving adjuvant hormonal therapy (aHT) alone, aRT alone, and aRT+aHT. OS was analyzed using Kaplan-Meier method and compared between the groups using the log-rank test. Multivariable Cox regression was used to identify covariates that affected OS.


RESULTS
A total of 7,225 patients were included in this analysis, of whom 3,636 (50.3%) received no adjuvant therapy, 2,041 (28.2%) received aHT alone, 350 (4.8%) received aRT alone, and 1,198 (16.5%) received aRT+aHT. The 5-year OS rates were 85.2% for no adjuvant therapy, 82.9% for aHT alone, 88.3% for aRT alone, and 88.8% for combination hormonal therapy, i.e., aRT+aHT (P<0.001). On multivariable analysis, aRT+aHT was associated with a significantly decreased risk of death (hazard ratio [HR] = 0.67; 95% CI: 0.54-0.83; P<0.001) compared with no adjuvant therapy, whereas aHT alone (HR = 0.99; 95% CI: 0.85-1.15; P = 0.90) and aRT alone (HR = 1.02; 95% CI: 0.74-1.40; P = 0.92) were not.


CONCLUSION
Patients treated with multimodal aRT+aHT had significantly higher OS rate than patients treated without adjuvant therapy or with aHT/aRT alone.
['Wong|Andrew T|AT|', 'Schwartz|David|D|', 'Osborn|Virginia|V|', 'Safdieh|Joseph|J|', 'Weiner|Joseph|J|', 'Schreiber|David|D|']
D000230:Adenocarcinoma D000368:Aged D000369:Aged, 80 and over D018931:Antineoplastic Agents, Hormonal D017024:Chemotherapy, Adjuvant D003131:Combined Modality Therapy D006801:Humans D053208:Kaplan-Meier Estimate D008197:Lymph Node Excision D008207:Lymphatic Metastasis D008297:Male D008875:Middle Aged D060787:Neoplasm Grading D011468:Prostatectomy D011471:Prostatic Neoplasms D018714:Radiotherapy, Adjuvant D015996:Survival Rate
Prostate cancer Outcomes Prostatectomy Combined modality therapy Radiotherapy