初始雄激素剥夺治疗后血红蛋白变化对新诊断转移性前列腺癌的预后价值：西南肿瘤协作组8894研究的多变量分析

The prognostic value of hemoglobin change after initiating androgen-deprivation therapy for newly diagnosed metastatic prostate cancer: A multivariate analysis of Southwest Oncology Group Study 8894.

作者信息

Beer Tomasz M, Tangen Catherine M, Bland Lisa B, Hussain Maha, Goldman Bryan H, DeLoughery Thomas G, Crawford E David

机构信息

Department of Medicine, Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon, USA.

出版信息

Cancer. 2006 Aug 1;107(3):489-96. doi: 10.1002/cncr.22029.

DOI:10.1002/cncr.22029

PMID:16804926

Abstract

BACKGROUND

The objective of this study was to characterize changes in hemoglobin (HGB) levels after the initiation of androgen-deprivation therapy (ADT) in patients with previously untreated, metastatic prostate cancer who were enrolled in a large clinical trial.

METHODS

The multivariate associations between 3-month change in HGB and baseline characteristics were evaluated with a linear regression model. The associations between 3-month change in HGB level and time-to-event outcomes, including overall survival and progression-free survival, were evaluated by using proportional hazards regression models.

RESULTS

Quartiles of baseline HGB levels were < or =12.0 g/dL, from 12.1 to 13.7 g/dL, from 13.8 to 14.7 g/dL, and >14.7 g/dL. Overall, 3 months after initiating ADT, the mean HGB level declined 0.54 g/dL (standard deviation [SD], 1.68 g/dL); however, the mean HGB level increased by 0.99 g/dL (SD, 1.83 g/dL) in patients who had baseline HGB levels <12 g/dL and decreased 1.04 g/dL (SD, 1.28 g/dL) in patients who had baseline HGB levels > or =12 g/dL. After adjusting for potential confounders, including baseline HGB level, a decline in HGB after 3 months of ADT was associated independently with shorter survival (hazards ratio [HR], 1.10 per 1 g/dL decline; P = .0035) and shorter progression-free survival (HR, 1.08 per 1 g/dL decline; P = .013). An unexpected finding was that the effect of baseline HGB on overall and progression-free survival varied significantly by race.

CONCLUSIONS

In a sample of men with newly diagnosed, metastatic prostate cancer, a decline in HGB level after 3 months of ADT was associated with shorter survival and progression-free survival after adjusting for disease status and other baseline covariates. Although race alone was not a strong predictor of death or disease progression, the effect of the baseline HGB level on overall and progression-free survival varied significantly by race.

摘要

背景

本研究的目的是描述在一项大型临床试验中入组的既往未接受治疗的转移性前列腺癌患者开始雄激素剥夺治疗（ADT）后血红蛋白（HGB）水平的变化特征。

方法

采用线性回归模型评估HGB三个月变化与基线特征之间的多变量关联。使用比例风险回归模型评估HGB水平三个月变化与包括总生存期和无进展生存期在内的事件发生时间结局之间的关联。

结果

基线HGB水平的四分位数分别为≤12.0 g/dL、12.1至13.7 g/dL、13.8至14.7 g/dL和＞14.7 g/dL。总体而言，开始ADT三个月后，平均HGB水平下降0.54 g/dL（标准差[SD]，1.68 g/dL）；然而，基线HGB水平＜12 g/dL的患者平均HGB水平升高0.99 g/dL（SD，1.83 g/dL），而基线HGB水平≥12 g/dL的患者平均HGB水平下降1.04 g/dL（SD，1.28 g/dL）。在调整包括基线HGB水平在内的潜在混杂因素后，ADT三个月后HGB下降与较短生存期（风险比[HR]，每下降1 g/dL为1.10；P = 0.0035）和较短无进展生存期（HR，每下降1 g/dL为1.08；P = 0.013）独立相关。一个意外发现是，基线HGB对总生存期和无进展生存期的影响因种族而异。