Personalized radiotherapy benefit prediction in non-surgically managed prostate adenocarcinoma: a prognostic nomogram...

Prostate adenocarcinoma (PCa) imposes a significant global health burden. Radiotherapy is a primary local treatment for non-surgically managed patients; however, reliable tools to predict which individuals will derive a survival benefit are lacking. This study aimed to develop a risk stratification model to evaluate survival benefits of radiotherapy in non-surgically treated PCa patients and identify subgroups likely to benefit from radiotherapy.

Data from 100,155 non-surgically treated PCa patients [2004-2015] were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. All-subsets regression and multivariate Cox regression were used to construct nomograms for overall survival (OS) and cancer-specific survival (CSS), quantifying survival risk and stratifying patients into low- and high-risk groups. Subgroup analyses based on risk stratification were conducted to assess the value of radiotherapy.

In the whole cohort, radiotherapy significantly improved 5-year OS (84.2% vs. 76.6%, P<0.001) and CSS (84.2% vs. 76.6%, P<0.001). After risk stratification, high-risk patients receiving radiotherapy exhibited 10.1% and 10.2% improvements in 5-year OS and CSS, respectively (both P<0.05). In contrast, low-risk patients demonstrated no CSS benefit (P>0.05) and reduced OS [hazard ratio (HR): 1.07, 95% confidence interval (CI): 1.02-1.13, P=0.01] following radiotherapy. In non-metastatic stage patients, the nomograms retained good discrimination and the pattern of radiotherapy benefit was consistent with the main analysis.

The developed nomograms effectively identify patients likely to benefit from radiotherapy. High-risk patients experience significant OS and CSS benefits, while radiotherapy is not recommended for low-risk patients.