Revisiting current National Comprehensive Cancer Network (NCCN) high-risk prostate cancer stratification: a National Cancer Database analysis
Background High-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk factors, as defined by National Comprehensive Cancer Network (NCCN) risk stratification, in prostate cancer patients undergoing ra...
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| Published in | Prostate cancer and prostatic diseases Vol. 27; no. 2; pp. 244 - 251 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
Nature Publishing Group UK
01.06.2024
Nature Publishing Group |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Background
High-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk factors, as defined by National Comprehensive Cancer Network (NCCN) risk stratification, in prostate cancer patients undergoing radical prostatectomy.
Methods
We queried the National Cancer Database from 2004 to 2018 for patients with non-metastatic high-risk prostate cancer who underwent radical prostatectomy and stratified them as Group H1: Prostate specific antigen (PSA) > 20 ng/ml alone, Group H2: cT3a stage alone and Group H3: Gleason Grade (GG) group 4/5 as per NCCN guidelines. The histopathological characteristics and rate of adjuvant therapy were compared between different groups. Inverse probability weighting (IPW)-adjusted Kaplan–Meier curves were utilized to compare overall survival (OS) in group H1 and H2 with H3.
Results
Overall, 61,491 high-risk prostate cancer patients were identified, and they were classified into Group H1 (
n
= 14,139), Group H2 (
n
= 2855) and Group H3 (
n
= 44,497). Compared to group H1 or H2, pathological GG group > 3 (
p
< 0.001), pathological stage pT3b or higher (
p
< 0.001), lymph nodal positive disease (pN1) (
p
< 0.001) and rate of adjuvant therapy (
p
< 0.001) were significantly in Group H3. IPW-adjusted Kaplan–Meier curves showed significantly better 5-year OS in group H1 compared to group H3 [95.1% vs 93.3%,
p
< 0.001] and group H2 compared to group H3 [94.4% vs 92.9%,
p
< 0.001].
Conclusion
PSA > 20 ng/ml or cT3a stage in isolation have better oncologic and survival outcomes compared to GG > 3 disease and sub-stratification of ‘High-risk’ category might lead to better patient prognostication. |
|---|---|
| AbstractList | High-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk factors, as defined by National Comprehensive Cancer Network (NCCN) risk stratification, in prostate cancer patients undergoing radical prostatectomy.BACKGROUNDHigh-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk factors, as defined by National Comprehensive Cancer Network (NCCN) risk stratification, in prostate cancer patients undergoing radical prostatectomy.We queried the National Cancer Database from 2004 to 2018 for patients with non-metastatic high-risk prostate cancer who underwent radical prostatectomy and stratified them as Group H1: Prostate specific antigen (PSA) > 20 ng/ml alone, Group H2: cT3a stage alone and Group H3: Gleason Grade (GG) group 4/5 as per NCCN guidelines. The histopathological characteristics and rate of adjuvant therapy were compared between different groups. Inverse probability weighting (IPW)-adjusted Kaplan-Meier curves were utilized to compare overall survival (OS) in group H1 and H2 with H3.METHODSWe queried the National Cancer Database from 2004 to 2018 for patients with non-metastatic high-risk prostate cancer who underwent radical prostatectomy and stratified them as Group H1: Prostate specific antigen (PSA) > 20 ng/ml alone, Group H2: cT3a stage alone and Group H3: Gleason Grade (GG) group 4/5 as per NCCN guidelines. The histopathological characteristics and rate of adjuvant therapy were compared between different groups. Inverse probability weighting (IPW)-adjusted Kaplan-Meier curves were utilized to compare overall survival (OS) in group H1 and H2 with H3.Overall, 61,491 high-risk prostate cancer patients were identified, and they were classified into Group H1 (n = 14,139), Group H2 (n = 2855) and Group H3 (n = 44,497). Compared to group H1 or H2, pathological GG group > 3 (p < 0.001), pathological stage pT3b or higher (p < 0.001), lymph nodal positive disease (pN1) (p < 0.001) and rate of adjuvant therapy (p < 0.001) were significantly in Group H3. IPW-adjusted Kaplan-Meier curves showed significantly better 5-year OS in group H1 compared to group H3 [95.1% vs 93.3%, p < 0.001] and group H2 compared to group H3 [94.4% vs 92.9%, p < 0.001].RESULTSOverall, 61,491 high-risk prostate cancer patients were identified, and they were classified into Group H1 (n = 14,139), Group H2 (n = 2855) and Group H3 (n = 44,497). Compared to group H1 or H2, pathological GG group > 3 (p < 0.001), pathological stage pT3b or higher (p < 0.001), lymph nodal positive disease (pN1) (p < 0.001) and rate of adjuvant therapy (p < 0.001) were significantly in Group H3. IPW-adjusted Kaplan-Meier curves showed significantly better 5-year OS in group H1 compared to group H3 [95.1% vs 93.3%, p < 0.001] and group H2 compared to group H3 [94.4% vs 92.9%, p < 0.001].PSA > 20 ng/ml or cT3a stage in isolation have better oncologic and survival outcomes compared to GG > 3 disease and sub-stratification of 'High-risk' category might lead to better patient prognostication.CONCLUSIONPSA > 20 ng/ml or cT3a stage in isolation have better oncologic and survival outcomes compared to GG > 3 disease and sub-stratification of 'High-risk' category might lead to better patient prognostication. High-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk factors, as defined by National Comprehensive Cancer Network (NCCN) risk stratification, in prostate cancer patients undergoing radical prostatectomy. We queried the National Cancer Database from 2004 to 2018 for patients with non-metastatic high-risk prostate cancer who underwent radical prostatectomy and stratified them as Group H1: Prostate specific antigen (PSA) > 20 ng/ml alone, Group H2: cT3a stage alone and Group H3: Gleason Grade (GG) group 4/5 as per NCCN guidelines. The histopathological characteristics and rate of adjuvant therapy were compared between different groups. Inverse probability weighting (IPW)-adjusted Kaplan-Meier curves were utilized to compare overall survival (OS) in group H1 and H2 with H3. Overall, 61,491 high-risk prostate cancer patients were identified, and they were classified into Group H1 (n = 14,139), Group H2 (n = 2855) and Group H3 (n = 44,497). Compared to group H1 or H2, pathological GG group > 3 (p < 0.001), pathological stage pT3b or higher (p < 0.001), lymph nodal positive disease (pN1) (p < 0.001) and rate of adjuvant therapy (p < 0.001) were significantly in Group H3. IPW-adjusted Kaplan-Meier curves showed significantly better 5-year OS in group H1 compared to group H3 [95.1% vs 93.3%, p < 0.001] and group H2 compared to group H3 [94.4% vs 92.9%, p < 0.001]. PSA > 20 ng/ml or cT3a stage in isolation have better oncologic and survival outcomes compared to GG > 3 disease and sub-stratification of 'High-risk' category might lead to better patient prognostication. Background High-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk factors, as defined by National Comprehensive Cancer Network (NCCN) risk stratification, in prostate cancer patients undergoing radical prostatectomy. Methods We queried the National Cancer Database from 2004 to 2018 for patients with non-metastatic high-risk prostate cancer who underwent radical prostatectomy and stratified them as Group H1: Prostate specific antigen (PSA) > 20 ng/ml alone, Group H2: cT3a stage alone and Group H3: Gleason Grade (GG) group 4/5 as per NCCN guidelines. The histopathological characteristics and rate of adjuvant therapy were compared between different groups. Inverse probability weighting (IPW)-adjusted Kaplan–Meier curves were utilized to compare overall survival (OS) in group H1 and H2 with H3. Results Overall, 61,491 high-risk prostate cancer patients were identified, and they were classified into Group H1 ( n = 14,139), Group H2 ( n = 2855) and Group H3 ( n = 44,497). Compared to group H1 or H2, pathological GG group > 3 ( p < 0.001), pathological stage pT3b or higher ( p < 0.001), lymph nodal positive disease (pN1) ( p < 0.001) and rate of adjuvant therapy ( p < 0.001) were significantly in Group H3. IPW-adjusted Kaplan–Meier curves showed significantly better 5-year OS in group H1 compared to group H3 [95.1% vs 93.3%, p < 0.001] and group H2 compared to group H3 [94.4% vs 92.9%, p < 0.001]. Conclusion PSA > 20 ng/ml or cT3a stage in isolation have better oncologic and survival outcomes compared to GG > 3 disease and sub-stratification of ‘High-risk’ category might lead to better patient prognostication. BackgroundHigh-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk factors, as defined by National Comprehensive Cancer Network (NCCN) risk stratification, in prostate cancer patients undergoing radical prostatectomy.MethodsWe queried the National Cancer Database from 2004 to 2018 for patients with non-metastatic high-risk prostate cancer who underwent radical prostatectomy and stratified them as Group H1: Prostate specific antigen (PSA) > 20 ng/ml alone, Group H2: cT3a stage alone and Group H3: Gleason Grade (GG) group 4/5 as per NCCN guidelines. The histopathological characteristics and rate of adjuvant therapy were compared between different groups. Inverse probability weighting (IPW)-adjusted Kaplan–Meier curves were utilized to compare overall survival (OS) in group H1 and H2 with H3.ResultsOverall, 61,491 high-risk prostate cancer patients were identified, and they were classified into Group H1 (n = 14,139), Group H2 (n = 2855) and Group H3 (n = 44,497). Compared to group H1 or H2, pathological GG group > 3 (p < 0.001), pathological stage pT3b or higher (p < 0.001), lymph nodal positive disease (pN1) (p < 0.001) and rate of adjuvant therapy (p < 0.001) were significantly in Group H3. IPW-adjusted Kaplan–Meier curves showed significantly better 5-year OS in group H1 compared to group H3 [95.1% vs 93.3%, p < 0.001] and group H2 compared to group H3 [94.4% vs 92.9%, p < 0.001].ConclusionPSA > 20 ng/ml or cT3a stage in isolation have better oncologic and survival outcomes compared to GG > 3 disease and sub-stratification of ‘High-risk’ category might lead to better patient prognostication. |
| Author | Garg, Harshit Liss, Michael A. Dursun, Furkan Kaushik, Dharam Alsayegh, Fadi Wu, Shenghui Wang, Hanzhang Mansour, Ahmed M. Svatek, Robert S. |
| Author_xml | – sequence: 1 givenname: Harshit surname: Garg fullname: Garg, Harshit organization: Department of Urology, University of Texas Health – sequence: 2 givenname: Furkan orcidid: 0000-0002-7756-634X surname: Dursun fullname: Dursun, Furkan organization: Department of Urology, University of Texas Health – sequence: 3 givenname: Fadi surname: Alsayegh fullname: Alsayegh, Fadi organization: Department of Urology, University of Texas Health – sequence: 4 givenname: Hanzhang surname: Wang fullname: Wang, Hanzhang organization: Department of Urology, University of Texas Health – sequence: 5 givenname: Shenghui surname: Wu fullname: Wu, Shenghui organization: Department of Population Health Science, University of Texas Health – sequence: 6 givenname: Michael A. orcidid: 0000-0001-6978-1026 surname: Liss fullname: Liss, Michael A. organization: Department of Urology, University of Texas Health, MD Anderson Mays Cancer Center – sequence: 7 givenname: Dharam surname: Kaushik fullname: Kaushik, Dharam organization: Department of Urology, University of Texas Health, MD Anderson Mays Cancer Center – sequence: 8 givenname: Robert S. surname: Svatek fullname: Svatek, Robert S. organization: Department of Urology, University of Texas Health, MD Anderson Mays Cancer Center – sequence: 9 givenname: Ahmed M. orcidid: 0000-0003-1068-9131 surname: Mansour fullname: Mansour, Ahmed M. email: ahmedmansour1st@hotmail.com organization: Department of Urology, University of Texas Health, MD Anderson Mays Cancer Center, Urology and Nephrology Center, Mansoura University |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36641534$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1007_s00345_024_04864_y crossref_primary_10_1007_s43440_023_00534_9 crossref_primary_10_1016_j_prnil_2024_09_003 crossref_primary_10_3390_ijms242015231 |
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High-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual... High-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk... BackgroundHigh-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual... |
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| SubjectTerms | 631/67/589/466 692/699/67/1059 Adjuvant therapy Biomedical and Life Sciences Biomedicine Cancer Research Clinical outcomes Health risks Medical databases Medical prognosis Metastases Prostate cancer Prostatectomy Reproductive Medicine Risk factors Surgical techniques Survival |
| Title | Revisiting current National Comprehensive Cancer Network (NCCN) high-risk prostate cancer stratification: a National Cancer Database analysis |
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