Susan Halabi, Chen-Yen Lin, and Ellen B. Kaplan, Duke University; Judd W. Moul, Duke Cancer Institute, Durham, NC; W. Kevin Kelly, Thomas Jefferson University, Philadelphia, PA; Karim S. Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif, France; Michael J. Morris, Memorial Sloan-Kettering Cancer Center, New York, NY; and Eric J. Small, University of California, San Francisco, San Francisco, CA.
J Clin Oncol. 2014 Mar 1;32(7):671-7. doi: 10.1200/JCO.2013.52.3696. Epub 2014 Jan 21.
Prognostic models for overall survival (OS) for patients with metastatic castration-resistant prostate cancer (mCRPC) are dated and do not reflect significant advances in treatment options available for these patients. This work developed and validated an updated prognostic model to predict OS in patients receiving first-line chemotherapy.
Data from a phase III trial of 1,050 patients with mCRPC were used (Cancer and Leukemia Group B CALGB-90401 [Alliance]). The data were randomly split into training and testing sets. A separate phase III trial served as an independent validation set. Adaptive least absolute shrinkage and selection operator selected eight factors prognostic for OS. A predictive score was computed from the regression coefficients and used to classify patients into low- and high-risk groups. The model was assessed for its predictive accuracy using the time-dependent area under the curve (tAUC).
The model included Eastern Cooperative Oncology Group performance status, disease site, lactate dehydrogenase, opioid analgesic use, albumin, hemoglobin, prostate-specific antigen, and alkaline phosphatase. Median OS values in the high- and low-risk groups, respectively, in the testing set were 17 and 30 months (hazard ratio [HR], 2.2; P < .001); in the validation set they were 14 and 26 months (HR, 2.9; P < .001). The tAUCs were 0.73 (95% CI, 0.70 to 0.73) and 0.76 (95% CI, 0.72 to 0.76) in the testing and validation sets, respectively.
An updated prognostic model for OS in patients with mCRPC receiving first-line chemotherapy was developed and validated on an external set. This model can be used to predict OS, as well as to better select patients to participate in trials on the basis of their prognosis.
转移性去势抵抗性前列腺癌（mCRPC）患者的总生存期（OS）预后模型已经过时，并未反映出这些患者可用治疗方案的显著进展。本研究旨在开发和验证一种更新的预后模型，以预测接受一线化疗的患者的 OS。
使用来自 mCRPC 三期临床试验（癌症和白血病组 B 试验 CALGB-90401 [Alliance]）的 1050 例患者的数据。将数据随机分为训练集和测试集。另一项三期临床试验作为独立验证集。适应性最小绝对收缩和选择算子（least absolute shrinkage and selection operator，LASSO）选择了 8 个与 OS 相关的预后因素。根据回归系数计算预测评分，并将患者分为低风险和高风险组。使用时间依赖性曲线下面积（area under the curve，AUC）来评估模型的预测准确性。
该模型包括东部肿瘤协作组（Eastern Cooperative Oncology Group，ECOG）表现状态、疾病部位、乳酸脱氢酶、阿片类镇痛药使用、白蛋白、血红蛋白、前列腺特异性抗原和碱性磷酸酶。测试集中高风险组和低风险组的中位 OS 值分别为 17 个月和 30 个月（风险比 [HR]，2.2；P <.001）；在验证集中，它们分别为 14 个月和 26 个月（HR，2.9；P <.001）。测试集和验证集的时间依赖性 AUC 分别为 0.73（95%CI，0.70 至 0.73）和 0.76（95%CI，0.72 至 0.76）。
我们开发并验证了一种用于接受一线化疗的 mCRPC 患者 OS 的更新预后模型。该模型可用于预测 OS，还可以根据患者的预后更好地选择参加试验的患者。
