title: Selecting the optimal candidate for adjuvant radiotherapy after radical prostatectomy for prostate cancer: a long-term survival analysis.
abstract: BACKGROUND
  The role of adjuvant radiotherapy (ART) after radical prostatectomy (RP) on survival of patients with prostate cancer (PCa) is still controversial.
  
  
  OBJECTIVE
  We tested the impact of ART on cancer-specific mortality (CSM) and overall mortality (OM) in PCa patients according to pathologic PCa features.
  
  
  METHODS
  We evaluated 1049 PCa patients treated with RP and extended pelvic lymph node dissection alone or in combination with adjuvant treatments between 1998 and 2008. All patients had positive surgical margins and/or pT3/pT4 disease with or without positive lymph nodes.
  
  
  METHODS
  Cox regression analyses tested the relationship between pathologic characteristics and CSM rates. Independent predictors of survival were used to develop a novel risk score based on the number of risk factors. Finally, Cox regression models tested the relationship between ART and survival according to the number of risk factors.
  
  
  CONCLUSIONS
  On multivariable analyses, only pathologic Gleason score ≥ 8, pT3b/T4 stage, and presence of positive lymph nodes represented independent predictors of CSM (all p ≤ 0.02). The cumulative number of these pathologic findings was used to develop a risk score, which was 0, 1, 2, and 3 in 43.6%, 22.1%, 20.7%, and 13.6% of patients, respectively. In patients sharing more than two mentioned predictors of CSM (primarily having a risk score of 0 or 1), ART did not significantly improve survival (all p ≥ 0.4). Conversely, in patients with a risk score ≥ 2, ART was associated with lower CSM and OM rates (all p=0.006). The observational nature of the cohort represents a limitation of the study.
  
  
  CONCLUSIONS
  ART significantly improved survival only in patients with at least two of the following pathologic features at RP: Gleason score ≥ 8, pT3/pT4 disease, and positive lymph nodes. These patients represent the ideal candidates for ART after RP.
authors.affiliation: Department of Urology, Vita-Salute University, San Raffaele, Milan, Italy. Firas.abdollah@gmail.com
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Cesare
authors.initials: C
authors.lastname: Cozzarini
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.forename: Niccolò Maria
authors.initials: NM
authors.lastname: Passoni
authors.forename: Claudio
authors.initials: C
authors.lastname: Fiorino
authors.forename: Nadia
authors.initials: N
authors.lastname: Di Muzio
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018579:Patient Selection; D010388:Pelvis; D016016:Proportional Hazards Models; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome