PMID- 25407865
OWN - NLM
STAT- MEDLINE
DCOM- 20150729
LR  - 20220408
IS  - 1879-8519 (Electronic)
IS  - 1879-8500 (Linking)
VI  - 4
IP  - 6
DP  - 2014 Nov-Dec
TI  - A comprehensive assessment of the prognostic utility of the Stephenson nomogram 
      for salvage radiation therapy postprostatectomy.
PG  - 422-9
LID - S1879-8500(14)00050-2 [pii]
LID - 10.1016/j.prro.2014.02.003 [doi]
AB  - PURPOSE: To investigate the prognostic utility of the Stephenson nomogram for 
      clinically relevant endpoints, freedom from metastasis (FFM), and prostate 
      cancer-specific survival (PCSS) in patients treated with salvage external beam 
      radiation therapy (SRT) following a rising prostate-specific antigen (PSA) after 
      radical prostatectomy (RP). METHODS AND MATERIALS: From an institutional cohort 
      of 575 patients treated with SRT between 1986 and 2010, the Stephenson nomogram 
      variables were retrospectively collected and available for 179 patients. The 
      prognostic impact of the Stephenson nomogram on 6-year freedom from biochemical 
      failure (FFBF), FFM, and PCSS was assessed on univariate and multivariate 
      analysis using Kaplan-Meier and Cox proportional hazards models. The prognostic 
      utility of the Stephenson nomogram was compared with individual pretreatment, 
      treatment, and clinical characteristics using concordance indices. RESULTS: In 
      the 179 patients with all available nomogram variables, median follow-up was 85.0 
      months (interquartile range [IQR], 53-113) and 6-year FFBF, FFM, and PCSS were 
      38% (95% confidence interval [CI], 30-46), 79% (95% CI, 73-85), and 96% (95% CI, 
      92-100), respectively. Univariate analysis, demonstrated that the Stephenson 
      nomogram, as a continuous variable and as a risk stratified group, was prognostic 
      of FFBF (both, P < .0001), FFM (both, P < .0001), and PCSS (both, P </= .0005). 
      When analyzing individual Stephenson nomogram variables, multivariate analysis 
      revealed that positive surgical margins (P = .02; hazard ratio [HR], 0.4; 95% CI, 
      0.2-0.8) and pre-RT PSA (P = .0001; HR, 1.6; 95% CI, 1.3-2.0) were prognostic for 
      FFM, while pre-RT PSA (P = .03; HR, 1.2; 95% CI, 1.0-1.4) was the only prognostic 
      variable for PCSS. Concordance indices revealed the Stephenson nomogram to have 
      superior prognostic capability for biochemical failure (0.71), distant metastasis 
      (0.75), and prostate cancer-specific mortality (0.75) when compared with 
      individual variables (BF all </= 0.65, DM all </= 0.67, PCSM all </= 0.71). 
      CONCLUSIONS: For patients treated with SRT for a rising PSA postprostatectomy, 
      the Stephenson nomogram is an appropriate prognostic tool for estimating the 
      response to treatment; however, there remains a need for improvement in current 
      and future nomograms.
FAU - Johnson, Skyler
AU  - Johnson S
AD  - Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
FAU - Jackson, William
AU  - Jackson W
AD  - Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
FAU - Speers, Corey
AU  - Speers C
AD  - Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
FAU - Feng, Felix
AU  - Feng F
AD  - Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
FAU - Hamstra, Daniel
AU  - Hamstra D
AD  - Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. 
      Electronic address: dhamm@umich.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140327
PL  - United States
TA  - Pract Radiat Oncol
JT  - Practical radiation oncology
JID - 101558279
SB  - IM
MH  - Aged
MH  - Cohort Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neoadjuvant Therapy
MH  - *Nomograms
MH  - Prognosis
MH  - Prostatectomy
MH  - Prostatic Neoplasms/mortality/pathology/*radiotherapy
MH  - Radiotherapy, Adjuvant
MH  - Salvage Therapy/*methods
EDAT- 2014/11/20 06:00
MHDA- 2015/07/30 06:00
CRDT- 2014/11/20 06:00
PHST- 2013/11/07 00:00 [received]
PHST- 2014/01/24 00:00 [revised]
PHST- 2014/02/11 00:00 [accepted]
PHST- 2014/11/20 06:00 [entrez]
PHST- 2014/11/20 06:00 [pubmed]
PHST- 2015/07/30 06:00 [medline]
AID - S1879-8500(14)00050-2 [pii]
AID - 10.1016/j.prro.2014.02.003 [doi]
PST - ppublish
SO  - Pract Radiat Oncol. 2014 Nov-Dec;4(6):422-9. doi: 10.1016/j.prro.2014.02.003. 
      Epub 2014 Mar 27.