title: Adjuvant radiation with hormonal therapy is associated with improved survival in men with pathologically involved lymph nodes after radical surgery for prostate cancer.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Patients treated with multimodal aRT+aHT had significantly higher OS rate than patients treated without adjuvant therapy or with aHT/aRT alone.
authors.affiliation: Department of Radiation Oncology, Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY. Electronic address: andrew.wong@downstate.edu.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Wong
authors.affiliation: Department of Radiation Oncology, Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: Department of Radiation Oncology, Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Virginia
authors.initials: V
authors.lastname: Osborn
authors.affiliation: Department of Radiation Oncology, Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Joseph
authors.initials: J
authors.lastname: Safdieh
authors.affiliation: Department of Radiation Oncology, Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Joseph
authors.initials: J
authors.lastname: Weiner
authors.affiliation: Department of Radiation Oncology, Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; 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 / Q000379:methods; D011471:Prostatic Neoplasms / Q000401:mortality / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: Combined modality therapy; Outcomes; Prostate cancer; Prostatectomy; Radiotherapy