title: Impact of adjuvant radiotherapy on survival of patients with node-positive prostate cancer.
abstract: OBJECTIVE
  The role of adjuvant radiotherapy (aRT) in treating patients with pN1 prostate cancer is controversial. We tested the hypothesis that the impact of aRT on cancer-specific mortality (CSM) in these individuals is related to tumor characteristics.
  
  
  METHODS
  We evaluated 1,107 patients with pN1 prostate cancer treated with radical prostatectomy and anatomically extended pelvic lymph node dissection between 1988 and 2010 at two tertiary care centers. All patients received adjuvant hormonal therapy with or without aRT. Regression tree analysis stratified patients into risk groups on the basis of their tumor characteristics and the corresponding CSM rate. Cox regression analysis tested the relationship between aRT and CSM rate, as well as overall mortality (OM) rate in each risk group separately.
  
  
  RESULTS
  Overall, 35% of patients received aRT. At multivariable analysis, aRT was associated with more favorable CSM rate (hazard ratio [HR], 0.37; P < .001). However, when patients were stratified into risk groups, only two groups of men benefited from aRT: (1) patients with positive lymph node (PLN) count ≤ 2, Gleason score 7 to 10, pT3b/pT4 stage, or positive surgical margins (HR, 0.30; P = .002); and (2) patients with PLN count of 3 to 4 (HR, 0.21; P = .02), regardless of other tumor characteristics. These results were confirmed when OM was examined as an end point.
  
  
  CONCLUSIONS
  The beneficial impact of aRT on survival in patients with pN1 prostate cancer is highly influenced by tumor characteristics. Men with low-volume nodal disease (≤ two PLNs) in the presence of intermediate- to high-grade, non-specimen-confined disease and those with intermediate-volume nodal disease (three to four PLNs) represent the ideal candidates for aRT after surgery.
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cozzarini
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Damiano
authors.initials: D
authors.lastname: Vizziello
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Firas Abdollah and Mani Menon, Henry Ford Hospital, Detroit, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Nazareno Suardi, Cesare Cozzarini, Giorgio Gandaglia, Nicola Fossati, Damiano Vizziello, Francesco Montorsi, and Alberto Briganti, Vita-Salute San Raffaele University, Milan, Italy; and Maxine Sun and Pierre I. Karakiewicz, University of Montreal Health Centre, Montreal, Quebec, Canada. briganti.alberto@hsr.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen