Tangen Catherine M, Faulkner James R, Crawford E David, Thompson Ian M, Hirano Daisaku, Eisenberger Mario, Hussain Maha
The Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
Clin Prostate Cancer. 2003 Jun;2(1):41-5. doi: 10.3816/cgc.2003.n.011.
The objective of this analysis is to identify baseline covariates that predict which patients will be long-term survivors with metastatic prostate cancer. We analyzed data from Southwest Oncology Group (SWOG) S8894, a clinical trial in men with newly diagnosed metastatic prostate cancer, to evaluate pretreatment characteristics associated with 10-year survival. There were 1286 eligible patients randomized to this study. Of these, 794 have been followed for > or = 10.5 years and are included in the analyses. Proportional odds models were used to predict 3 survival categories (survival for < 5 years, 5 up to 10 years, and > or = 10 years). Baseline patient and disease characteristics investigated were protocol treatment (flutamide vs. placebo), severity of disease, SWOG performance status (PS), bone pain, Gleason score, race, age, and prostate-specific antigen (PSA) level at study entry. Of the 794 evaluable patients, 77% lived < 5 years, 16% lived 5 up to 10 years, and 7% lived > or = 10 years. Factors predicting a statistical significant association with longer survival (P < 0.05) included minimal disease, better PS, no bone pain, lower Gleason score, and lower PSA level. All but PS were also significant in multivariate analyses. However, only 13% of patients (5 of 38) who lived > or = 10 years were correctly predicted in their survival category based on the model, whereas 98% (405 of 414) who died within the first 5 years were correctly predicted. Although statistically significant baseline characteristics were identified in this clinical trial, they did not accurately predict the survival interval to which a patient belonged.
本分析的目的是确定能够预测哪些转移性前列腺癌患者会成为长期幸存者的基线协变量。我们分析了西南肿瘤协作组（SWOG）S8894的数据，这是一项针对新诊断的转移性前列腺癌男性患者的临床试验，以评估与10年生存率相关的治疗前特征。有1286名符合条件的患者被随机分配到本研究中。其中，794名患者已被随访≥10.5年，并纳入分析。使用比例优势模型预测3种生存类别（生存时间<5年、5至10年、≥10年）。所研究的基线患者和疾病特征包括方案治疗（氟他胺与安慰剂）、疾病严重程度、SWOG体能状态（PS）、骨痛、 Gleason评分、种族、年龄以及研究入组时的前列腺特异性抗原（PSA）水平。在794名可评估患者中，77%的患者生存时间<5年，16%的患者生存时间为5至10年，7%的患者生存时间≥10年。预测与较长生存期有统计学显著关联（P<0.05）的因素包括疾病轻微、较好的PS、无骨痛、较低的Gleason评分和较低的PSA水平。除PS外，所有因素在多变量分析中也具有显著性。然而，根据该模型，在生存时间≥10年的患者中，只有13%（38名中的5名）的生存类别被正确预测，而在最初5年内死亡的患者中，98%（414名中的405名）被正确预测。尽管在该临床试验中确定了具有统计学显著性的基线特征，但它们并不能准确预测患者所属的生存区间。
