National Comprehensive Cancer Network (NCCN) classification is associated with long-term outcomes in patients with localized prostate cancer, according to study results presented at the NCCN 2023 Annual Conference.

Patients who were classified as high risk at baseline according to NCCN guidelines had significantly worse long-term outcomes than patients who were classified as intermediate risk at baseline, said study presenter Abdenour Nabid, MD, of the University of Sherbrooke in Quebec, Canada.

Dr Nabid and colleagues conducted this study using data from a pair of phase 3 trials that included 1230 patients with localized prostate cancer. The trials were conducted at 11 cancer centers in Canada from October 2000 to September 2010. 

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About half of patients (n=600) were classified as intermediate risk, and the other half (n=630) were classified as high risk. The 2 groups were similar in terms of age, Zubrod score, and comorbidities. 

At baseline, patients in the intermediate-risk group were more likely than those in the high-risk group to have T1-T2a stage disease (74.7% vs 44.1%; P <.0001), a Gleason score of 6 or less (24.8% vs 13.3%; P <.0001), and a lower prostate-specific antigen level (median, 10.5 ng/ml vs 16 ng/ml; P <.0001).

At a median follow-up of 14.29 years, all outcomes were significantly worse in the high-risk group than in the intermediate-risk group. 

The intermediate-risk group had a lower rate of biochemical failure than the high-risk group (22.3% vs 30.6%; P =.001). The intermediate-risk group also had lower rates of distant metastasis (6.8% vs 13.3%; P <.001) and prostate cancer-specific mortality (5.3% vs 12.1%; P <.001).

The intermediate-risk group had a higher rate of distant metastasis-free survival than the high-risk group (52% vs 35.4%; P <.001) and a higher rate of overall survival than the high-risk group (53% vs 36.8%; P <.001). 

The time to adverse outcomes was shorter among patients with high-risk disease than among those with intermediate-risk disease.

In a multivariable analysis, high-risk classification was associated with worse outcomes, including:

  • Prostate cancer-specific mortality (hazard ratio [HR], 2.10; 95% CI, 1.38-3.20; P <.0001) 
  • Distant metastasis (HR, 1.80; 95% CI, 1.23-2.64; P <.01)
  • Biochemical failure (HR, 1.41; 95% CI, 1.13-1.76; P <.01)
  • Distant metastasis-free survival (HR, 1.40; 95% CI, 1.2-1.64; P <.0001)
  • Overall survival (HR, 1.38; 95% CI, 1.18-1.62; P <.0001). 

“In a very homogeneous population, treated at the same time by the same centers …, NCCN classification used upfront demonstrated its ability to discriminate outcomes between intermediate- and high-risk prostate cancer,” Dr Nabid concluded.


Nabid A, Carrier N, Vigneault E, et al. Comparison of outcomes using NCCN classification in two concurrent phase III trials in intermediate and high risk prostate cancer: Long-term data. NCCN 2023. March 31-April 2, 2023. Abstract CLO23-025.