BACKGROUND The aim of the study was to analyse the prognostic factors in postoperative prostate cancer irradiation and develop a nomogram for disease-free survival (DFS). PATIENTS AND METHODS This retrospective study included 236 consecutive prostate cancer patients who had radical prostatectomy followed by radiotherapy (RT) at a single tertiary institution between 2009 and 2014. The main outcome was DFS analysed through uni- and multivariable analysis, Kaplan-Meier curves, log-rank testing, recursive partitioning analysis, and nomogram development. RESULTS The median follow up was 62.3 (interquartile range [IQR] 38.1-79) months. The independent clinical factors associated with increased risk of recurrence or progression in the multivariate analysis (MVA) were prostate-specific antigen (PSA) level before RT, pT3 characteristic, and local failure as salvage indication. The value of PSA nadir had a significant impact on the risk of biochemical failure. Biochemical control and DFS were significantly different depending on treatment indication (p < 0.0001). The recursive partitioning analysis highlighted the importance of the PSA level before RT, Gleason Grade Group, PSA nadir, and local failure as a treatment indication. Finally, the nomogram for DFS was developed and is available online at https://apps.konsta.com.pl/app/prostate-salvage-dfs/. CONCLUSIONS The Pre-RT PSA level, pT3 characteristic and local failure as salvage indication are pivotal prognostic factors associated with increased risk of recurrence or progression. The Gleason grade group of 4-5 and PSA nadir value allow for further risk stratification. The treatment outcomes in postoperative prostate cancer irradiation are significantly different depending on treatment indication. An online nomogram comprising of both pre-treatment and current data was developed allowing for visualization of changes in prognosis depending on clinical data.

中文翻译：

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前列腺癌术后放疗的预后因素——三级中心经验。

背景 本研究的目的是分析前列腺癌术后放疗的预后因素，并制定无病生存 (DFS) 列线图。患者和方法 这项回顾性研究包括 236 名连续的前列腺癌患者，这些患者在 2009 年至 2014 年期间在一个单一的三级机构接受了根治性前列腺切除术和放疗 (RT)。主要结果是通过单变量和多变量分析、Kaplan-Meier 曲线、对数秩检验、递归分区分析和列线图开发。结果 中位随访时间为 62.3（四分位距 [IQR] 38.1-79）个月。多变量分析 (MVA) 中与复发或进展风险增加相关的独立临床因素是放疗前前列腺特异性抗原 (PSA) 水平、pT3 特征、和作为补救指示的局部故障。PSA 最低点的值对生化失败的风险有显着影响。根据治疗适应症的不同，生化控制和 DFS 有显着差异（p < 0.0001）。递归分区分析强调了放疗前 PSA 水平、格里森等级组、PSA 最低点和局部失败作为治疗指征的重要性。最后，开发了 DFS 的列线图，可在 https://apps.konsta.com.pl/app/prostate-salvage-dfs/ 在线获取。结论 放疗前 PSA 水平、pT3 特征和作为挽救指征的局部失败是与复发或进展风险增加相关的关键预后因素。4-5 的格里森等级组和 PSA 最低值允许进一步的风险分层。前列腺癌术后放疗的治疗效果因治疗适应症而异。开发了一个包含治疗前和当前数据的在线列线图，允许根据临床数据可视化预后的变化。