Bellmunt J, Carles J, Albanell J
Department of Medical Oncology, University Hospital del Mar-IMIM, Barcelona, Spain.
Clin Transl Oncol. 2009 Feb;11(2):82-5. doi: 10.1007/s12094-009-0318-x.
Because the evidence is not yet solid enough to strongly recommend whether or not to treat hormone-refractory prostate cancer (HRPC) patients at certain stages of the disease, predictive models might help in decision making. The importance of prognostic models lies in their ability to capture clinically relevant and measurable variables for routine use by clinicians to inform patients, and improve palliation and treatment decisions. Basically this allows for the creation of homogeneous prognostic strata for randomised comparative trials of therapeutic agents. In the last few years different models to predict patient outcome in HRPC have been published in the literature. Recently, based on the phase III randomised trial of docetaxel, a multivariate prognostic model incorporating PSA kinetics has been developed to predict survival at 1, 2 and 5 years in metastatic HRPC men treated with chemotherapy. This novel model includes new independent clinical prognostic factors in addition to PSA-DT such as baseline pain, type of progression at baseline (measurable disease or bone scan compared with PSA only), presence of liver metastases and the number of metastatic disease sites. This nomogram will be a helpful tool to stratify patients for further docetaxel-based trials and could also help us to delineate the potential benefits of chemotherapy at certain points during the natural history of HRPC.
由于现有证据尚不够确凿，难以就是否在疾病的某些阶段对激素难治性前列腺癌（HRPC）患者进行治疗给出强有力的推荐，预测模型可能有助于做出决策。预后模型的重要性在于其能够获取临床相关且可测量的变量，供临床医生日常使用，以便告知患者情况，并改善姑息治疗和治疗决策。基本上，这使得能够为治疗药物的随机对照试验创建同质的预后分层。在过去几年中，文献中已发表了多种预测HRPC患者预后的模型。最近，基于多西他赛的III期随机试验，开发了一种纳入PSA动力学的多变量预后模型，以预测接受化疗的转移性HRPC男性患者1年、2年和5年的生存率。这个新模型除了PSA-DT外，还纳入了新的独立临床预后因素，如基线疼痛、基线时的进展类型（可测量疾病或仅与PSA相比的骨扫描）、肝转移的存在以及转移病灶的数量。这种列线图将是一个有用的工具，可对患者进行分层，以便开展进一步的基于多西他赛的试验，还能帮助我们明确在HRPC自然病程的某些阶段化疗的潜在益处。
