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The Clinical Cell-Cycle Risk (CCR) Score Is Associated With Metastasis After Radiation Therapy and Provides Guidance on When to Forgo Combined Androgen Deprivation Therapy With Dose-Escalated Radiation.

  • Tward, Jonathan1
  • Lenz, Lauren2
  • Flake, Darl D II,2
  • Rajamani, Saradha2
  • Yonover, Paul3
  • Olsson, Carl4
  • Kapoor, Deepak A4
  • Mantz, Constantine5
  • Liauw, Stanley L6
  • Antic, Tatjana7
  • Fabrizio, Michael8
  • Salzstein, Daniel9
  • Shore, Neal10
  • Albertson, Dan11
  • Henderson, Jonathan12
  • Lee, Steve P13
  • Gay, Hiram A14
  • Michalski, Jeff14
  • Hung, Arthur15
  • Raben, David16
  • And 7 more
  • 1 Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. Electronic address: [email protected]
  • 2 Myriad Genetics, Inc, Salt Lake City, Utah.
  • 3 UroPartners, Chicago, Illinois.
  • 4 Advanced Radiation Center of New York, New Hyde Park, New York, and Integrated Medical Professionals, North Hills, New York.
  • 5 21st Century Oncology, Fort Meyers, Florida.
  • 6 Department of Radiation Oncology, University of Chicago Medical Center, Chicago, Illinois.
  • 7 Department of Pathology, University of Chicago Medical Center, Chicago, Illinois.
  • 8 Urology of San Antonio, San Antonio, TX.
  • 9 Urology of Virginia, Norfolk, Virginia.
  • 10 Carolina Urologic Research Center, Myrtle Beach, South Carolina.
  • 11 Department of Anatomic Pathology and Molecular Oncology, University of Utah, Salt Lake City, Utah.
  • 12 Regional Urology, LLC, Shreveport, Louisiana.
  • 13 Department of Radiation Oncology, Long Beach VA Medical Center, Long Beach, California.
  • 14 Department of Radiation Oncology, Washington University, St. Louis, Missouri.
  • 15 Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon.
  • 16 University of Colorado, Aurora, Colorado.
  • 17 Department of Urology, Greater Los Angeles-VA Medical Center, Los Angeles, California.
  • 18 Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
  • 19 Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina.
Published Article
International journal of radiation oncology, biology, physics
Publication Date
May 01, 2022
DOI: 10.1016/j.ijrobp.2021.09.034
PMID: 34610388


The clinical cell-cycle risk (CCR) score, which combines the University of California, San Francisco's Cancer of the Prostate Risk Assessment (CAPRA) and the cell cycle progression (CCP) molecular score, has been validated to be prognostic of disease progression for men with prostate cancer. This study evaluated the ability of the CCR score to prognosticate the risk of metastasis in men receiving dose-escalated radiation therapy (RT) with or without androgen deprivation therapy (ADT). This retrospective, multi-institutional cohort study included men with localized National Comprehensive Cancer Network (NCCN) intermediate-, high-, and very high-risk prostate cancer (N = 741). Patients were treated with dose-escalated RT with or without ADT. The primary outcome was time to metastasis. The CCR score prognosticated metastasis with a hazard ratio (HR) per unit score of 2.22 (95% confidence interval [CI], 1.71-2.89; P < .001). The CCR score better prognosticated metastasis than NCCN risk group (CCR, P < .001; NCCN, P = .46), CAPRA score (CCR, P = .002; CAPRA, P = .59), or CCP score (CCR, P < .001; CCP, P = .59) alone. In bivariable analyses, CCR score remained highly prognostic when accounting for ADT versus no ADT (HR, 2.18; 95% CI, 1.61-2.96; P < .001), ADT duration as a continuous variable (HR, 2.11; 95% CI, 1.59-2.79; P < .001), or ADT given at or below the recommended duration for each NCCN risk group (HR, 2.19; 95% CI, 1.69-2.86; P < .001). Men with CCR scores below or above the multimodality threshold (CCR score, 2.112) had a 10-year risk of metastasis of 3.7% and 21.24%, respectively. Men with below-threshold scores receiving RT alone had a 10-year risk of metastasis of 3.7%, and for men receiving RT plus ADT, the 10-year risk of metastasis was also 3.7%. The CCR score accurately and precisely prognosticates metastasis and adds clinically actionable information relative to guideline-recommended therapies based on NCCN risk in men undergoing dose-escalated RT with or without ADT. For men with scores below the multimodality threshold, adding ADT may not significantly reduce their 10-year risk of metastasis. Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

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