Predictive factors for progression to metastatic castration-resistant prostate cancer
- Journal of Third Military Medical University Vol. 43, Issue 5, Pages: 425-431(2021)
- 作者机构：
- 作者简介：
- 基金信息：the National Natural Science Foundation for Young Scholars of China(81802558);the Special Scientific Research Project on Military Health Care(17BJZ13)
DOI：10.16016/j.1000-5404.202009081
CLC：Received：10 September 2020，
Published：15 March 2021
- 稿件说明：
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Xintao TAN, Zhuowei HUANG, Qiuli LIU, et al. Predictive factors for progression to metastatic castration-resistant prostate cancer[J]. Journal of Third Military Medical University, 2021, 43(5): 425-431.
Xintao TAN, Zhuowei HUANG, Qiuli LIU, et al. Predictive factors for progression to metastatic castration-resistant prostate cancer[J]. Journal of Third Military Medical University, 2021, 43(5): 425-431. DOI： 10.16016/j.1000-5404.202009081.
摘要
Abstract
Objective
2
To explore the predictive factors of metastatic prostate cancer progression to castration resistance and establish a risk prediction model.
Methods
2
Clinical data of 118 prostate cancer patients with bone metastasis who were diagnosed in our department from January 2010 to July 2020
initially received adjuvant endocrine therapy (AET) and then advanced to metastatic castration-resistant prostate cancer (mCRPC) were collected and retrospectively analyzed. The clinical information
including age
having diabetes or not
taking metformin or not
prostate specific antigen (PSA) level at diagnosis
nadir levels of PSA and testosterone
time to the nadirs
Gleason score
number of bone metastases
and serum levels of alkaline phosphatase
hemoglobin
albumin
lactate dehydrogenase
uric acid and cystatin C were collected and analyzed.
Chi
-square test was used to compare the differences of factors between groups with rapid and slow onset of CRPC. Kaplan-Meier survival analysis and Cox multivariate risk proportional regression model were used to compare the time difference of progression to CRPC in different groups. Cox risk proportional regression model was used to analyze and evaluate the effect of these factors on the time of CRPC progression
and a risk prediction model was established
and then the receiver operating characteristic (ROC) curve was used to detect the accuracy of the model.
Results
2
The median time for progression to CRPC was 17 (9.5~28.0) months. Univariate analysis indicated that the PSA nadir level
time to PSA nadir level
levels of alkaline phosphatase and lactate dehydrogenase
and number of bone metastases were significantly correlated with the time of progression to CRPC (
P
<
0.05). The results of multivariate analysis showed that the PSA nadir level (
HR
=2.549
95%
CI
: 1.565~4.151
P
<
0.001)
time to PSA nadir level (
HR
=0.373
95%
CI
: 0.227~0.612
P
<
0.001)
number of bone metastases (
HR
=2.393
95%
CI
: 1.292~4.43
P
=0.006)
lactate dehydrogenase level (
HR
=1.681
95%
CI
: 1.045~2.703
P
=0.032) were independent risk factors for short-term progression to CRPC. Based on these 4 independent risk factors
a risk prediction model was established. The equation is pi=1.788×(the PSA nadir level)-1.275×(the time to PSA nadir level) +0.441×(lactate dehydrogenase level) +1.114×(number of bone metastases)-1.5. The area under ROC curve was 0.812 (95%
CI
: 0.731~0.893
P
<
0.001
β=0.041). The sensitivity
specificity and Youden index were 0.803
0.718 and 0.521
respectively.
Conclusion
2
The PSA nadir level
time to PSA nadir value
number of bone metastases
lactate dehydrogenase level are independent risk factors for progression to mCRPC after androgen deprivation therapy (ADT) in prostate cancer patients with bone metastasis. Based on these 4 factors
the establishment of CRPC prediction model can improve the accuracy of prediction.
关键词
Keywords
references
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