Development of a prognostic model for survival time prediction in castration-resistant prostate cancer patients.

Abstract

BACKGROUND:

To identify predictors of survival in patients treated with docetaxel chemotherapy for castration-resistant prostate cancer (CRPC).

METHODS:

We retrospectively analyzed clinical data from 186 patients who underwent docetaxel chemotherapy for CRPC from 2005 to 2016 at a single center. Pretreatment baseline variables including demographic and clinicopathological data were reviewed. Disease progression was defined by imaging and/or consecutive prostate-specific antigen (PSA) elevation. The systemic immune-inflammation index (SII), the modified Glasgow Prognostic Score (mGPS), and the neutrophil-lymphocyte ratio (NLR) were calculated. Univariable and multivariable Cox proportional hazards regression analyses reporting hazard ratios assessed the risk for disease progression and overall survival (OS). A survival nomogram was constructed.

RESULTS:

Most patients (n = 139, 74.7%) completed at least 6 cycles of docetaxel chemotherapy. 156 patients (82.9%) experienced disease progression during the studied period. Only mGPS was independently associated with disease progression in a multivariable model (P < 0.01). During the studied period, 98 patients (52.1%) died. The built survival nomogram included statistically significant variables for OS in univariable analysis: hemoglobin, PSA, alkaline phosphatase (AP), lactate dehydrogenase, SII, neutrophil-lymphocyte ratio, mGPS, and site of metastases; and had a concordance index of 0.703. At decision curve analysis, the nomogram led to superior outcomes for any decision associated with a threshold probability of above 40%. In multivariable analysis, only AP (P = 0.02), hemoglobin and PSA (P < 0.01, respectively) remained associated with OS.

CONCLUSIONS:

PSA, AP, and hemoglobin are independent prognosticators for OS. Although mGPS is a promising marker for tumor progression and SII is a plausible prognostic marker for OS, valid integration of inflammatory indices into a prognostic model requires validation studies. Predictive and prognostic biomarkers are desperately needed to guide physicians in treatment counseling given the heterogeneous nature of CRPC and the plethora of effective therapies.

• Authors: Judith Stangl-Kremser, Andrea Mari, Rodrigo Suarez-Ibarrola, David D'Andrea, Stephan M Korn, Mario Pones, Gero Kramer, Pierre Karakiewicz, Dimitri V Enikeev, Petri V Glybochko, Alberto Briganti, Shahrokh F Shariat
• Journal: Urologic oncology (Urol Oncol) Vol. 38 Issue 6 Pg. 600.e9-600.e15 (06 2020) ISSN: 1873-2496 [Electronic] United States
• PMID: 31953003 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents
• Docetaxel

Topics

• Aged
• Antineoplastic Agents (therapeutic use)
• Docetaxel (therapeutic use)
• Humans
• Male
• Middle Aged
• Models, Statistical
• Prognosis
• Prostatic Neoplasms, Castration-Resistant (drug therapy, mortality)
• Retrospective Studies
• Survival Rate
• Time Factors