Beyond D'Amico risk classes for predicting recurrence after external beam radiotherapy for prostate cancer: the Candiolo classifier

• Published in: Radiation oncology (London, England) Vol. 11; no. 24; p. 23
• Main Authors: Gabriele, Domenico, Jereczek-Fossa, Barbara A, Krengli, Marco, Garibaldi, Elisabetta, Tessa, Maria, Moro, Gregorio, Girelli, Giuseppe, Gabriele, Pietro
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 24-02-2016; BioMed Central
• Subjects: Aged; Algorithms; Biopsy; Care and treatment; Databases, Factual; Disease-Free Survival; Follow-Up Studies; Humans; Imaging, Three-Dimensional - methods; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local; Neoplasm Staging; Patient outcomes; Preoperative Period; Prognosis; Proportional Hazards Models; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - mortality; Prostatic Neoplasms - radiotherapy; Radiotherapy; Radiotherapy - methods; Radiotherapy, Intensity-Modulated - methods; Regression Analysis; Reproducibility of Results; Retrospective Studies; Risk; Severity of Illness Index
• ISSN: 1748-717X; 1748-717X
• DOI: 10.1186/s13014-016-0599-5

The aim of this work is to develop an algorithm to predict recurrence in prostate cancer patients treated with radical radiotherapy, getting up to a prognostic power higher than traditional D'Amico risk classification.
Two thousand four hundred ninety-three men belonging to the EUREKA-2 retrospective multi-centric database on prostate cancer and treated with external-beam radiotherapy as primary treatment comprised the study population. A Cox regression time to PSA failure analysis was performed in univariate and multivariate settings, evaluating the predictive ability of age, pre-treatment PSA, clinical-radiological staging, Gleason score and percentage of positive cores at biopsy (%PC). The accuracy of this model was checked with bootstrapping statistics. Subgroups for all the variables' combinations were combined to classify patients into five different "Candiolo" risk-classes for biochemical Progression Free Survival (bPFS); thereafter, they were also applied to clinical PFS (cPFS), systemic PFS (sPFS) and Prostate Cancer Specific Survival (PCSS), and compared to D'Amico risk grouping performances.
The Candiolo classifier splits patients in 5 risk-groups with the following 10-years bPFS, cPFS, sPFS and PCSS: for very-low-risk 90 %, 94 %, 100 % and 100 %; for low-risk 74 %, 88 %, 94 % and 98 %; for intermediate-risk 60 %, 82 %, 91 % and 92 %; for high-risk 43 %, 55 %, 80 % and 89 % and for very-high-risk 14 %, 38 %, 56 % and 70 %. Our classifier outperforms D'Amico risk classes for all the end-points evaluated, with concordance indexes of 71.5 %, 75.5 %, 80 % and 80.5 % versus 63 %, 65.5 %, 69.5 % and 69 %, respectively.
Our classification tool, combining five clinical and easily available parameters, seems to better stratify patients in predicting prostate cancer recurrence after radiotherapy compared to the traditional D'Amico risk classes.