The clinical cell-cycle risk (CCR) score, which combines the University of California San Francisco Cancer of the Prostate Risk Assessment (CAPRA) and the cell cycle progression (CCP) molecular score, has been validated to be prognostic of disease progression for men with prostate cancer.
This study evaluated the ability of the CCR score to prognosticate the risk of metastasis in men receiving dose-escalated radiation therapy (RT) with or without androgen deprivation therapy (ADT).
This retrospective, multi-institutional cohort study included men with localized National Comprehensive Cancer Network (NCCN) intermediate-, high-, and very high-risk prostate cancer (N=741). Patients were treated with dose-escalated RT ± ADT. The primary outcome was time to metastasis.
CCR score prognosticated metastasis [hazard ratio per unit score (HR) 2.22, 95% confidence interval (CI) 1.71-2.89, p<0.001]. CCR score better prognosticated metastasis than NCCN risk group (CCR p <0.001; NCCN p = 0.46), CAPRA score (CCR p = 0.002; CAPRA p = 0.59), or CCP score (CCR p <0.001; CCP p = 0.59) alone. In bivariable analyses, CCR score remained highly prognostic when accounting for ADT vs. no ADT (HR 2.18, 95% CI 1.61-2.96, p<0.001), ADT duration as a continuous variable (HR 2.11, 95% CI 1.59-2.79, p<0.001), or ADT given at or below the recommended duration for each NCCN risk group (HR 2.19, 95% CI 1.69-2.86, p<0.001). Men with CCR scores below or above the multimodality threshold (CCR=2.112) had a 10-year risk of metastasis of 3.7% and 21.24%, respectively. Men with below-threshold scores receiving RT alone had a 3.7% 10-year risk of metastasis whereas for men receiving RT plus ADT, 10-year risk of metastasis was 3.7%.
CCR score accurately and precisely prognosticates metastasis and adds clinically actionable information relative to guideline-recommended therapies based on NCCN risk in men undergoing dose-escalated RT ±ADT. Men with scores below the multimodality threshold may not significantly reduce their 10-year risk of metastasis by adding ADT.
International journal of radiation oncology, biology, physics. 2021 Oct 02 [Epub ahead of print]
Jonathan Tward, Lauren Lenz, Darl D Flake, Saradha Rajamani, Carl Olsson, Deepak A Kapoor, Constantine Mantz, Stanley L Liauw, Tatjana Antic, Neal Shore, Dan Albertson, Jonathan Henderson, Steve P Lee, Hiram A Gay, Jeff Michalski, Arthur Hung, David Raben, Isla Garraway, Michael S Lewis, Paul L Nguyen, David T Marshall, Michael K Brawer, Steven Stone, Todd Cohen
Huntsman Cancer Institute, University of Utah, UT. Electronic address: ., Myriad Genetics, Inc., Salt Lake City, UT., Advanced Radiation Center of New York, New Hyde Park, NY, and Integrated Medical Professionals, North Hills, NY., 21st Century Oncology, Fort Meyers, FL., University of Chicago Medical Center, Chicago, IL., Carolina Urologic Research Center, Myrtle Beach, SC., University of Utah Department of Anatomic Pathology and Molecular Oncology, Salt Lake City UT., Regional Urology, LLC, Shreveport, LA., Long Beach VA Medical Center, Long Beach, CA., Department of Radiation Oncology, Washington University, St. Louis, MO., Oregon Health & Science University, Portland, OR., University of Colorado, Aurora, CO., Greater Los Angeles-VA Medical Center, Los Angeles, CA., Dana-Farber Cancer Institute, Boston, MA., Medical University of South Carolina, Charleston, SC.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/34610388
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