Shusuke Akamatsu1, Masashi Kubota1, Ryuji Uozumi2, Shintaro Narita3, Masahiro Takahashi4, Koji Mitsuzuka4, Shingo Hatakeyama5, Toshihiko Sakurai6, Sadafumi Kawamura7, Shigeto Ishidoya8, Senji Hoshi9, Masanori Ishida10, Kei Mizuno11, Keiji Ogura12, Takayuki Goto1, Naoki Terada1, Takashi Kobayashi1, Toshinari Yamasaki1, Takahiro Inoue1, Norihiko Tsuchiya6, Chikara Ohyama5, Yoichi Arai4, Tomonori Habuchi3, Satoshi Morita2, Osamu Ogawa13. 1. Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan. 2. Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan. 3. Department of Urology, Akita University Graduate School of Medicine, Akita, Japan. 4. Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan. 5. Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. 6. Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan. 7. Department of Urology, Miyagi Cancer Center, Sendai, Japan. 8. Department of Urology, Sendai City Hospital, Sendai, Japan. 9. Department of Urology, Yamagata Prefectural Central Hospital, Yamagata, Japan. 10. Department of Urology, Iwate Prefectural Isawa Hospital, Oshu, Japan. 11. Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Japan. 12. Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Japan. 13. Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: ogawao@kuhp.kyoto-u.ac.jp.
Abstract
BACKGROUND: There has been growth in the treatment options for castration-sensitive metastatic prostate cancer (mPCa), but without clear guidance for risk stratification. OBJECTIVE: To identify clinical parameters associated with overall survival (OS) and establish a prognostic model for use with treatment-naïve castration-sensitive mPCa. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of 304 patients treated at Kyoto University Hospital was performed. A prognostic model was created using clinical parameters associated with OS. The model was externally validated in an independent cohort of 520 patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable analysis was performed to identify the clinical parameters associated with OS. Risk scores were calculated using Cox proportional hazards analysis for each combination of risk factors, and patients were grouped into categories based on those scores. RESULTS AND LIMITATIONS: Over 80% of the cohort had a Gleason sum score ≥8. The median OS was 53mo among patients with CHAARTED high-volume PCa (n=172) and 131mo among those with low-volume PCa (n=100). Independent factors associated with OS were extent of disease score ≥2 or the presence of liver metastasis; lactate dehydrogenase >250U/L; and a primary Gleason score of 5. The median OS for the high-, intermediate-, and low-risk groups according to the new model were 28mo, 59mo, and not reached, respectively; the corresponding values in the validation cohort were 41mo, 63mo, and not reached. Harrell's C-index was 0.649. CONCLUSIONS: Our simple and reproducible prognostic model for treatment-naïve castration-sensitive mPCa could aid in risk stratification and treatment selection. PATIENT SUMMARY: We identified clinical parameters associated with prognosis in castration-sensitive metastatic prostate cancer and established a reproducible prognostic model that could be used to guide treatment decisions.
BACKGROUND: There has been growth in the treatment options for castration-sensitive metastatic prostate cancer (mPCa), but without clear guidance for risk stratification. OBJECTIVE: To identify clinical parameters associated with overall survival (OS) and establish a prognostic model for use with treatment-naïve castration-sensitive mPCa. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of 304 patients treated at Kyoto University Hospital was performed. A prognostic model was created using clinical parameters associated with OS. The model was externally validated in an independent cohort of 520 patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable analysis was performed to identify the clinical parameters associated with OS. Risk scores were calculated using Cox proportional hazards analysis for each combination of risk factors, and patients were grouped into categories based on those scores. RESULTS AND LIMITATIONS: Over 80% of the cohort had a Gleason sum score ≥8. The median OS was 53mo among patients with CHAARTED high-volume PCa (n=172) and 131mo among those with low-volume PCa (n=100). Independent factors associated with OS were extent of disease score ≥2 or the presence of liver metastasis; lactate dehydrogenase >250U/L; and a primary Gleason score of 5. The median OS for the high-, intermediate-, and low-risk groups according to the new model were 28mo, 59mo, and not reached, respectively; the corresponding values in the validation cohort were 41mo, 63mo, and not reached. Harrell's C-index was 0.649. CONCLUSIONS: Our simple and reproducible prognostic model for treatment-naïve castration-sensitive mPCa could aid in risk stratification and treatment selection. PATIENT SUMMARY: We identified clinical parameters associated with prognosis in castration-sensitive metastatic prostate cancer and established a reproducible prognostic model that could be used to guide treatment decisions.
Authors: Soumyajit Roy; Yilun Sun; Cristopher J D Wallis; Scott C Morgan; Daniel E Spratt; Fred Saad; Shawn Malone; Scott Grimes; Julia Malone; Amar U Kishan; Dibya Mukherjee Journal: Prostate Cancer Prostatic Dis Date: 2022-07-05 Impact factor: 5.554