非常高风险（VHR）前列腺癌是高风险前列腺癌的一种具有侵袭性的亚群，其特征为前列腺特异性抗原水平高、Gleason评分高和/或T分期晚期。现代管理范式包括高级分子影像技术和多模式治疗，采用加强的前列腺定向或全身治疗资源，在高容量中心更易得到。为了考察放射设施的病例数量和非常高风险前列腺癌患者的总生存期（OS）之间的关系，我们进行了一项回顾性队列研究，研究时间从2022年11月11日到2023年3月4日，并分析了报道给美国国家癌症数据库的设施的数据。纳入了根据全国综合癌症网络标准（临床T3b-T4分期、主要Gleason模式5、>4个核心中有4-5级别组和/或2-3个高危特征）诊断为非转移性非常高风险前列腺癌并接受了具有治愈意图的放射治疗和雄激素剥夺治疗的男性患者，时间跨度从2004年1月1日到2016年12月31日。将高和低年均累积场馆容量（ACFV）的治疗进行比较，ACFV定义为患者所在治疗场馆从2004年到诊断年份的前列腺放射治疗病例总数。通过马汀残差图检验连续ACFV与OS之间的非线性关系；通过偏倚调整的对数秩检验确定了最佳的ACFV截断点，该点最大化了高和低ACFV之间的区别。采用Kaplan-Meier分析和加权的倒数概率积分分数调整以及多变量Cox比例风险模型进行高和低ACFV的总生存期评估。共识别了25,219名非常高风险前列腺癌患者（中位年龄71岁[IQR，64-76岁]；78.7%为白人），其中6438名（25.5%）在高ACFV场馆接受治疗。中位随访时间为57.4个月（95% CI, 56.7-58.1）。在高ACFV中心接受治疗的患者的中位OS为123.4个月（95% CI, 116.6-127.4），而低ACFV中心的为109.0个月（95% CI, 106.5-111.2），两者差异显著（P<.001）。多变量分析显示在高ACFV中心接受治疗与较低死亡风险相关（风险比0.89；95% CI, 0.84-0.95；P<.001）。在基于倒数概率积分分数加权的调整后，这些结果仍然是显著的。在这个接受了放射治疗和雄激素剥夺治疗的非常高风险前列腺癌患者的队列研究中，设施的病例数量与更长的OS存在独立关联。需要进一步研究确定高容量中心特有的因素可能是造成这种益处的原因。

Very high-risk (VHR) prostate cancer is an aggressive substratum of high-risk prostate cancer, characterized by high prostate-specific antigen levels, high Gleason score, and/or advanced T category. Contemporary management paradigms involve advanced molecular imaging and multimodal treatment with intensified prostate-directed or systemic treatment-resources more readily available at high-volume centers.To examine radiation facility case volume and overall survival (OS) in men with VHR prostate cancer.A retrospective cohort study was performed from November 11, 2022, to March 4, 2023, analyzing data from US facilities reporting to the National Cancer Database. Patients included men diagnosed with nonmetastatic VHR prostate cancer by National Comprehensive Cancer Network criteria (clinical T3b-T4 category, primary Gleason pattern 5, >4 cores with grade group 4-5, and/or 2-3 high-risk features) and treated with curative-intent radiotherapy and androgen deprivation therapy between January 1, 2004, to December 31, 2016.Treatment at high- vs low-average cumulative facility volume (ACFV), defined as the total number of prostate radiotherapy cases at an individual patient's treatment facility from 2004 until the year of their diagnosis. The nonlinear association between a continuous ACFV and OS was examined through a Martingale residual plot; an optimal ACFV cutoff was identified that maximized the separation between high vs low ACFV via a bias-adjusted log rank test.Overall survival was assessed between high vs low ACFV using Kaplan-Meier analysis with and without inverse probability score weighted adjustment and multivariable Cox proportional hazards.A total of 25 219 men (median age, 71 [IQR, 64-76] years; 78.7% White) with VHR prostate cancer were identified, 6438 (25.5%) of whom were treated at high ACFV facilities. Median follow-up was 57.4 (95% CI, 56.7-58.1) months. Median OS for patients treated at high ACFV centers was 123.4 (95% CI, 116.6-127.4) months vs 109.0 (95% CI, 106.5-111.2) months at low ACFV centers (P < .001). On multivariable analysis, treatment at a high ACFV center was associated with lower risk of death (hazard ratio, 0.89; 95% CI, 0.84-0.95; P < .001). These results were also significant after inverse probability score weighted-based adjustment.In this cohort study of patients with VHR prostate cancer who underwent definitive radiotherapy and androgen deprivation therapy, facility case volume was independently associated with longer OS. Further studies are needed to identify which factors unique to high-volume centers may be responsible for this benefit.