Persistent under-utilization of adjuvant radiotherapy in patients with adverse pathological features at radical prostatectomy: A national cancer database (NCDB) analysis

Document Type

Conference Proceeding

Publication Date

2019

Publication Title

Eur Urol Suppl

Abstract

Introduction & Objectives: Three trials showed the benefit of adjuvant radiotherapy (aRT)in patients with any adverse pathological features at the time of radical prostatectomy (RP). Additionally, recent retrospective data showed that patients with very aggressive features are the ones that benefit the most from aRT. Our objective was to examine the utilization of aRT over the last decade in patients with any adverse features, and in those with very aggressive features, and its impact on survival. Materials & Methods: Three trials showed the benefit of adjuvant radiotherapy (aRT)in patients with any adverse pathological features at the time of radical prostatectomy (RP). Additionally, recent retrospective data showed that patients with very aggressive features are the ones that benefit the most from aRT. Our objective was to examine the utilization of aRT over the last decade in patients with any adverse features, and in those with very aggressive features, and its impact on survival. Results: In patients with any adverse features, only 11.7% (22,320)received aRT, and this rate changed from 12.9% in 2004 to 12.2% in 2015 (p= 0.009). Likewise, of 20,583 patients with very aggressive features, only 28.9% (5967)received aRT, and this rate changed from 27.9% in 2004 to 29.6% in 2015 (p=0.4). At propensity score-matched analysis, and in patients with any adverse pathology, the 120-month OS was 72.0% in aRT patients vs. 72.4% in patients without aRT (p=0.3). In patients with very aggressive features, this rate was 56.6% in aRT patients vs. 53.7% in patients without aRT (p=.008)After adjusting for confounders, in patients with any adverse pathological features, aRT was not an independent predictor of OS (HR: 1.01 95% CI 0.94-1.08 p-value: 0.6). Conversely, in individuals with very aggressive pathological features, aRT patients had more favorable OS rate (HR: 0.88 95% CI, 0.80-0.98, p-value: 0.01), when compared to their non-aRT counterparts. Conclusions: On a national level, there is a severe underutilization of aRT, which did not improve over time. This is true even in patients with very aggressive pathological features. This indicates a sub-optimal quality of care, especially given the evident survival benefit of aRT in the latter group of patients. While a similar benefit was not evident in our cohort of patients with any adverse pathological features, this might be due to the severe selection bias against aRT in clinical practice. That said, our findings highlight an important quality-of-care concern, and urgent efforts are needed to improve the current practice pattern in the United States.

Volume

18

Issue

1

First Page

e969

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