Local failure, distant metastasis, and survival after definitive radiotherapy for intermediate- and high-risk prostate cancer: An individual patient-level meta-analysis of 18 randomized trials.

Authors

Martin Ma

Ting Martin Ma

Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA

Ting Martin Ma , Fang-I Chu , Tahmineh Romero , Jeff M. Michalski , Thomas Michael Pisansky , Mack Roach III, Felix Y Feng , Howard M. Sandler , Michel Bolla , Anouk Neven , Luca Incrocci , Matthew R. Sydes , Abdenour Nabid , James William Denham , Allison Steigler , Luis Souhami , John Armstrong , Shawn Malone , Daniel Eidelberg Spratt , Amar Upadhyaya Kishan

Organizations

Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, University of California Los Angeles, Los Angeles, CA, Department of Medicine Statistics Core, University of California, Los Angeles, CA, Department of Radiation Oncology, Washington University, St. Louis, MO, Mayo Clinic, Rochester, MN, University of California San Francisco, San Francisco, CA, Department of Urology, University of California, San Francisco, CA, Cedars-Sinai Medical Center, Los Angeles, CA, Grenoble Alpes University, Centre Hospitalier Universitaire de Grenoble, Grenoble, France, European Organisation for Research and Treatment of Cancer, Brussels, Belgium, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands, MRC Clinical Trials Unit at UCL, London, United Kingdom, Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada, University of Newcastle, Callaghan, Australia, University of Newcastle School of Medicine and Public Health, Newcastle, Australia, McGill University Health Centre, Montréal, QC, Canada, ICORG (All Ireland Cooperative Oncology Research Group), St Luke's Hospital, Radiation Oncology Department, Dublin, Ireland, The Ottawa Hospital Cancer Center, Ottawa, ON, Canada, University Hospitals Seidman Cancer Center, Cleveland, OH

Research Funding

Other Foundation

Background: The prognostic importance of local failure (LF) after definitive radiotherapy (RT) in patients with NCCN intermediate- (IRPCa) and high-risk prostate cancer (HRPCa) remains unclear, particularly given the likelihood that occult distant metastases (DMs) at presentation may be the true driver of natural history. Here, we leverage individual patient data (IPD) from 18 randomized control trials (RCTs) to evaluate the prognostic impact of LF and the kinetics of DM after RT. Methods: IPD for 18 RCTs were obtained from the Meta-Analysis of Randomized trials in Cancer of the Prostate (MARCAP) Consortium, comprising a total of 12533 patients (6288 HRPCa & 6245 IRPCa). Multivariable Cox proportional hazards (PH) models were developed to evaluate the relationship between overall survival (OS), PCa-specific survival (PCSS), DM-free survival (DMFS) & LF as a time-dependent covariate, adjusted for clinicodemographic parameters. Markov PH models, defined via transitions between 4 states, were developed to evaluate the aforementioned relationship. Proportional hazards assumption was imposed and examined for both models. Time is from randomization. Results: Median follow-up was 9.1 years. There were 795 (13%) LF & 1288 (21%) DM events for patients with HRPCa; these numbers were 449 (7%) & 451 (7%) for IRPCa. For HRPCa & IRPCa, 81% and 81% of DMs developed from a clinically relapse-free state (cRFS), with a median time of 46 and 60 months, respectively (p < 0.0001). 39% & 13% of DM events occurred within 2 years after RT for HRPCa & IRPCa, respectively. At later time points, DM events were more likely to emerge after an LF event for both HRPCa (9% vs. 34% between 0-2 vs. 8-10 years post-RT, p = 0.001) and IRPCa (10% vs. 34% between 0-2 vs. 8-10 years post-RT, p = 0.008). LF was significantly associated with OS (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.06–1.30), PCSS (HR 2.02, 95% CI 1.75-2.33) & DMFS (HR 1.94, 95% CI 1.75–2.15) (p < 0.01 for all) in patients with HRPCa. LF was also significantly associated with DMFS (HR 1.57, 95% CI 1.36–1.81) but not OS in patients with IRPCa. Patients who had not transitioned to the LF state had a significantly lower HR of transitioning to a PCa-specific death state than those who transitioned to the LF state (HR 0.32, 95% CI 0.21–0.50, p < 0.001). Conclusions: LF is an independent prognosticator of OS, PCSS & DMFS in HRPCa and of DMFS in IRPCa. The predominant mode of DM development is from the cRFS state, underscoring the importance of accurate upfront staging & systemic therapy. However, particularly at late time points, an increasing proportion of DM events originated after diagnosis of a LF, constituting a “second wave” of DM events. This suggests that optimizing local control is also important, though the majority of DM events appear prior to a clinically-detected LF.

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Abstract Details

Meeting

2022 ASCO Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Prostate Cancer

Track

Prostate Cancer - Advanced,Prostate Cancer - Localized

Sub Track

Other

Citation

J Clin Oncol 40, 2022 (suppl 6; abstr 277)

DOI

10.1200/JCO.2022.40.6_suppl.277

Abstract #

277

Poster Bd #

M8

Abstract Disclosures