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01-12-2019 | Topic Paper

Importance of metastatic volume in prognostic models to predict survival in newly diagnosed metastatic prostate cancer

Authors: Sarah Buelens, Elise De Bleser, Bert Dhondt, Wesley Verla, Karel Decaestecker, Piet Ost, Valérie Fonteyne, Kathia De Man, Chloë Standaert, Sylvie Rottey, Nicolaas Lumen

Published in: World Journal of Urology | Issue 12/2019

Abstract

Purpose

To explore the prognostic importance of metastatic volume in a contemporary daily practice cohort of patients with newly diagnosed metastatic hormone-naive prostate cancer (mHNPC) and to develop a pragmatic prognostic model to predict survival for these patients.

Methods

Since 2014, 113 patients with newly diagnosed mHNPC were prospectively registered. Statistical analysis was performed using SPSS 25.0™ with two-sided p value < 0.05 indicating statistical significance. Univariate and multivariate cox regression analyses were performed to identify prognostic risk factors. Kaplan–Meier method with log-rank statistics was constructed to analyze difference in survival in the prognostic groups. Model performance was assessed using the Concordance-index (C-index) and cross-validated in R v3.4.1. High-volume mHNPC (HVD) was defined as the presence of visceral metastasis or ≥ 4 bone metastases with ≥ 1 appendicular lesion.

Results

Multivariate analysis identified HVD (p = 0.047) and elevated alkaline phosphatase (ALP) (p = 0.018) as independent prognostic risk factors for overall survival (OS). Consequently, three prognostic groups were created: a good (no risk factors), intermediate (1 risk factor) and poor prognosis group (2 risk factors). Median OS for the good, intermediate and poor prognosis group was not reached, 73 and 20 months (95% CI 9–31 months with p < 0.001 and Correspondence-index of 0.78), respectively.

Conclusions

We developed a pragmatic and qualitative prognostic model consisting of three prognostic risk groups for OS in a daily practice cohort of patients with newly diagnosed mHNPC. Independent prognostic risk factors included in the model were HVD and abnormal ALP.

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Huggins C (1941) Studies on prostatic cancer. Arch Surg 43(2):209. https://doi.org/10.1001/archsurg.1941.01210140043004 CrossRef

Cornford P, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol 71(4):630–642. https://doi.org/10.1016/j.eururo.2016.08.002 CrossRefPubMed

James ND, Spears MR, Clarke NW et al (2015) Survival with newly diagnosed metastatic prostate cancer in the docetaxel era: data from 917 patients in the control arm of the STAMPEDE trial (MRC PR08, CRUK/06/019). Eur Urol 67(6):1028–1038. https://doi.org/10.1016/j.eururo.2014.09.032 CrossRefPubMed

Sweeney CJ, Chen Y-H, Carducci M et al (2015) Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med 373(8):737–746. https://doi.org/10.1056/NEJMoa1503747 CrossRefPubMedPubMedCentral

James ND, Sydes MR, Clarke NW et al (2016) Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet 387(10024):1163–1177. https://doi.org/10.1016/S0140-6736(15)01037-5 CrossRefPubMedPubMedCentral

Fizazi K, Tran N, Fein L et al (2017) Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med. https://doi.org/10.1056/nejmoa1704174 CrossRefPubMed

James ND, de Bono JS, Spears MR et al (2017) Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med. https://doi.org/10.1056/nejmoa1702900 CrossRefPubMedPubMedCentral

Halabi S, Lin C-Y, Kelly WK et al (2014) Updated prognostic model for predicting overall survival in first-line chemotherapy for patients with metastatic castration-resistant prostate cancer. J Clin Oncol 32(7):671–677. https://doi.org/10.1200/JCO.2013.52.3696 CrossRefPubMedPubMedCentral

Van Praet C, Rottey S, Van Hende F et al (2017) Which factors predict overall survival in patients with metastatic castration-resistant prostate cancer treated with abiraterone acetate post-docetaxel? Clin Genitourin Cancer. https://doi.org/10.1016/j.clgc.2017.01.019 CrossRefPubMed

10.

Smaletz O, Scher HI, Small EJ et al (2002) Nomogram for overall survival of patients with progressive metastatic prostate cancer after castration. J Clin Oncol 20(19):3972–3982. https://doi.org/10.1200/JCO.2002.11.021 CrossRefPubMed

11.

Armstrong AJ, Garrett-Mayer ES, Yang Y-CO, de Wit R, Tannock IF, Eisenberger M (2007) A contemporary prognostic nomogram for men with hormone-refractory metastatic prostate cancer: a TAX327 study analysis. Clin Cancer Res 13(21):6396–6403. https://doi.org/10.1158/1078-0432.CCR-07-1036 CrossRefPubMed

12.

Glass TR, Tangen CM, Crawford ED, Thompson I (2003) Metastatic carcinoma of the prostate: identifying prognostic groups using recursive partitioning. J Urol 169(1):164–169. https://doi.org/10.1097/01.ju.0000042482.18153.30 CrossRefPubMed

13.

Gravis G, Boher J-M, Fizazi K et al (2015) Prognostic factors for survival in noncastrate metastatic prostate cancer: validation of the glass model and development of a novel simplified prognostic model. Eur Urol 68(2):196–204. https://doi.org/10.1016/j.eururo.2014.09.022 CrossRefPubMed

14.

Tait C, Moore D, Hodgson C et al (2014) Quantification of skeletal metastases in castrate-resistant prostate cancer predicts progression-free and overall survival. BJU Int 114(6b):E70–E73. https://doi.org/10.1111/bju.12717 CrossRefPubMed

15.

Klaff R, Varenhorst E, Berglund A et al (2016) Clinical presentation and predictors of survival related to extent of bone metastasis in 900 prostate cancer patients. Scand J Urol 50(5):352–359. https://doi.org/10.1080/21681805.2016.1209689 CrossRefPubMed

16.

Epstein JI, Egevad L, Amin MB et al (2015) The 2014 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma. Am J Surg Pathol 40(2):1. https://doi.org/10.1097/pas.0000000000000530 CrossRef

17.

Mottet N, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71(4):618–629. https://doi.org/10.1016/j.eururo.2016.08.003 CrossRefPubMed

18.

Efron B, Tibshirani R (1997) Improvements on cross-validation: the. 632 + Bootstrap method. J Am Stat Assoc 92(438):548–560

19.

Buelens S, Poelaert F, Dhondt B et al (2018) Metastatic burden in newly diagnosed hormone-naive metastatic prostate cancer: comparing definitions of CHAARTED and LATITUDE trial. Urol Oncol Semin Orig Investig 36(4):158.e13–158.e20. https://doi.org/10.1016/j.urolonc.2017.12.009 CrossRef

Title: Importance of metastatic volume in prognostic models to predict survival in newly diagnosed metastatic prostate cancer
Authors: Sarah Buelens
Elise De Bleser
Bert Dhondt
Wesley Verla
Karel Decaestecker
Piet Ost
Valérie Fonteyne
Kathia De Man
Chloë Standaert
Sylvie Rottey
Nicolaas Lumen
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 12/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2449-6

At a glance: The STEP trials

Springer Medicine

Importance of metastatic volume in prognostic models to predict survival in newly diagnosed metastatic prostate cancer

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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