title: Risk stratification system and pattern of relapse in patients treated with adjuvant radiotherapy after radical prostatectomy.
abstract: OBJECTIVE
  To retrospectively evaluate the role of adjuvant radiotherapy (ART) as monotherapy in a cohort of prostate cancer patients with undetectable prostate-specific antigen (PSA) after surgery and to propose a risk stratification system.
  
  
  METHODS
  Between 2003 and 2010, 174 consecutive patients were treated with ART (median dose 71 Gy) at a single institution. Subsequently, we assigned a score of 1 to the following risk factors (RF): T stage ≥3b, presurgical PSA ≥10 ng/mL, pathologic Gleason score (GS) ≥4 + 3, and positive surgical margin (R1). The scores were then summed to stratify the population into low risk (LR), intermediate risk (IR), and high risk (HR).
  
  
  RESULTS
  Median follow-up was 61 months (range 4-105). Five-year biochemical relapse-free survival (bRFS), clinical relapse-free survival (cRFS), and overall survival (OS) were respectively 93%, 97.1%, and 98.6%. On univariate analyses, GS was the only variable related to bRFS (p = 0.04) and to cRFS (p = 0.05). Any variable was related to OS. Kaplan-Meier analysis showed that HR patients (3-4 RF) had a worse bRFS (p = 0.02) compared to LR patients (0 RF or R1 as single RF); IR patients (1-2 RF) had a lower bRFS compared to LR patients (p = 0.06). Patients with R1 as single RF have the same bRFS as patients with 0 RF (p = 0.6) and are considered as LR patients.
  
  
  CONCLUSIONS
  Adjuvant radiotherapy leads to excellent bRFS and cRFS rates at 5 years (93.3% and 97.1%, respectively) in our population. Patients with multiple RF are at higher risk of bRFS. Patients with R1 as single RF have bRFS rates comparable to patients without any RF.
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Turin - Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Levis
authors.affiliation: Radiation Oncology, AOU City of the Health and of the Science, Turin, Turin - Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Guarneri
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Turin - Italy.|Present address: Radiation Oncology, Sacro Cuore-Don Calabria Hospital, Negrar-Verona - Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Giaj Levra
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY - USA.|Present address: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI - USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Spratt
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Turin - Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Bartoncini
authors.affiliation: Radiation Oncology, AOU City of the Health and of the Science, Turin, Turin - Italy.|Present address: Radiation Oncology, Tomotherapy Unit, Regional Hospital U. Parini, Aosta - Italy.
authors.forename: Fernando
authors.initials: F
authors.lastname: Munoz
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Turin - Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Trino
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Turin - Italy.|Present address: Radiation Oncology, University Hospitals Leuven/KU Leuven, Leuven - Belgium.
authors.forename: Angela
authors.initials: A
authors.lastname: Botticella
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Turin - Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Arcadipane
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Turin - Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology*; D009367:Neoplasm Staging; D017785:Photons / Q000627:therapeutic use; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen