之前的研究表明，短期雄激素剥夺疗法（ADT）联合放疗（RT）治疗前列腺癌的效益取决于竞争风险。为了确定一种定量方法来通过竞争事件风险（omega得分）将患者分层，以识别哪些亚组会受益于ADT。进行了NRG/RTOG 9408三期试验（NCT00002597）的辅助分析，共涉及1945名前列腺癌患者。采用短期ADT，我们应用广义竞争事件回归模型，包括年龄，身体状况，合并症，T分期，Gleason评分（GS）和前列腺特异抗原（PSA），将患者分层，根据原发癌相关事件（远处转移或前列腺癌死亡）与竞争性非癌症死亡的相对危险性来评估患者。我们使用omega得分测试ADT与通过标准风险标准与相对风险（RR）定义的亚组之间的交互作用。 T2b，更高的GS和更高的PSA与癌症相关与竞争性死亡事件的相对风险（更高的omega得分）增加相关；年龄和合并症增加则相关性降低。在低风险/有利中间风险（FIR）疾病的996名患者中，286名（28.7％）有高omega得分（≥0.314）。在768名不利的中间风险疾病患者中，175名（22.8％）有低omega得分。风险分类的总体不一致性为26.1％。标准标准和omega得分均确定了对低风险/高风险亚组中ADT对癌症相关事件和晚期死亡的影响的显着交互作用。在低风险/FIR亚组中，omega得分更高的患者明确有益于ADT明显降低癌症事件和提高事件无关生存率。局限性在于需要外部/前瞻性验证和比现代标准更低的RT剂量。基于竞争事件风险的分层对于确定哪些前列腺癌患者会受益于ADT是有用的。我们分析了通过癌症与非癌症事件相对危险（RR）定义的患者在当地前列腺癌中雄激素剥夺疗法（ADT）的有效性。在传统低风险/有利中间风险疾病患者中，那些具有较高RR的患者受益于短期ADT。版权所有©2023年欧洲泌尿外科协会。由Elsevier B.V.出版。保留所有权利。

Previous studies indicate that the benefit of short-term androgen deprivation therapy (ADT) with radiotherapy (RT) for prostate cancer depends on competing risks.To determine whether a quantitative method to stratify patients by risk for competing events (omega score) could identify subgroups that selectively benefit from ADT.An ancillary analysis of NRG/RTOG 9408 phase 3 trial (NCT00002597) involving 1945 prostate cancer patients was conducted.Short-term ADT.We applied generalised competing event regression models incorporating age, performance status, comorbidity, T category, Gleason score (GS), and prostate-specific antigen (PSA), to stratify patients according to relative hazards for primary cancer-related events (distant metastasis or prostate cancer death) versus competing noncancer mortality. We tested interactions between ADT and subgroups defined by standard risk criteria versus relative risk (RR) using the omega score.T2b, higher GS, and higher PSA were associated with an increased RR for cancer-related versus competing mortality events (a higher omega score); increased age and comorbidity were associated with a decreased omega score. Of 996 patients with low-risk/favourable intermediate-risk (FIR) disease, 286 (28.7%) had a high omega score (≥0.314). Of 768 patients with unfavourable intermediate-risk disease, 175 (22.8%) had a low omega score. The overall discordance in risk classification was 26.1%. Both standard criteria and omega score identified significant interactions for the effect of ADT on cancer-related events and late mortality in low- versus high-risk subgroups. Within the low-risk/FIR subgroup, a higher omega score identified patients in whom ADT significantly reduced cancer events and improved event-free survival. Limitations are the need for external/prospective validation and lower RT doses than contemporary standards.Stratification based on competing event risk is useful for identifying prostate cancer patients who selectively benefit from ADT.We analysed the effectiveness of androgen deprivation therapy (ADT) for localised prostate cancer among patients, defined by the relative risk (RR) for cancer versus noncancer events. Among patients with traditional low-risk/favourable intermediate-risk disease, those with a higher RR benefitted from short-term ADT.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.