Departments of Medicine and Urology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Departments of Medicine and Urology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Oncologist. 2018 Jul;23(7):791-797. doi: 10.1634/theoncologist.2017-0564. Epub 2018 Apr 26.
Metastatic castrate-resistant prostate cancer (mCRPC) patients with liver metastases have a poor prognosis. No large studies have investigated the clinical and biochemical parameters associated with liver metastases in this population.
Patient data made available via Project Data Sphere were collected from 1,281 men with mCRPC who were enrolled on to three phase III clinical trials for the treatment of their disease. Multiple logistic regression was performed on eight clinical and biochemical baseline variables to test their association with the presence of liver metastases on baseline radiographic imaging. Variables of interest included prior docetaxel exposure, Eastern Cooperative Oncology Group performance status, albumin, alkaline phosphatase, alanine transaminase, aspartate transaminase (AST), hemoglobin (HGB), lactate dehydrogenase (LDH), prostate-specific antigen, and total bilirubin. Final models were compared when treating the variables as either continuous or categorized.
Multiple variable analysis demonstrated that an increasing serum AST or LDH or a decreasing HGB was associated with an increased probability of having documented radiographic liver metastases ( < .0001). The area under the curve for the continuous model was 0.6842 and 0.6890 for the categorical one, with the latter model containing a dichotomized AST and LDH based on the upper limit of normal and tertile ranges of HGB based on the distribution of the outcome.
Our analysis demonstrated a significant association between the presence of liver metastases and laboratory levels of AST, LDH, and HGB. These have implications for patient management. More research is needed to validate these biomarkers and prospectively determine their application in the clinical setting.
The purpose of this study was to evaluate biochemical and clinical biomarkers associated with the presence of liver metastases in men diagnosed with metastatic castrate-resistant prostate cancer. The results indicate that quantitative assessments of aspartate transaminase, lactate dehydrogenase, and hemoglobin are significantly associated with an increased probability of having documented radiographic liver metastases. Analysis of these simple variables can alert clinicians to those at high risk for prostate cancer that has spread to the liver, a finding of clear importance for clinical management.
患有肝转移的去势抵抗性前列腺癌（mCRPC）患者预后较差。没有大型研究调查过该人群中与肝转移相关的临床和生化参数。
通过 Project Data Sphere 提供的患者数据来自 1281 名患有 mCRPC 的男性，他们参加了三项针对其疾病治疗的 III 期临床试验。对 8 个临床和生化基线变量进行多项逻辑回归，以测试它们与基线影像学上存在肝转移的相关性。感兴趣的变量包括先前的多西他赛暴露、东部合作肿瘤学组表现状态、白蛋白、碱性磷酸酶、丙氨酸转氨酶、天冬氨酸转氨酶（AST）、血红蛋白（HGB）、乳酸脱氢酶（LDH）、前列腺特异性抗原和总胆红素。当将变量视为连续变量或分类变量时，对最终模型进行比较。
多变量分析表明，血清 AST 或 LDH 升高或 HGB 降低与有记录的放射性肝转移的概率增加相关（ < .0001）。连续模型的曲线下面积为 0.6842，分类模型为 0.6890，后者模型基于正常上限和 HGB 分布的三分位范围对 AST 和 LDH 进行了二分法处理。
我们的分析表明，肝转移的存在与 AST、LDH 和 HGB 的实验室水平之间存在显著关联。这些对患者管理具有重要意义。需要进一步研究来验证这些生物标志物，并前瞻性地确定它们在临床环境中的应用。
本研究旨在评估与诊断为转移性去势抵抗性前列腺癌的男性肝转移存在相关的生化和临床生物标志物。结果表明，天冬氨酸转氨酶、乳酸脱氢酶和血红蛋白的定量评估与有记录的放射性肝转移的概率增加显著相关。对这些简单变量的分析可以提醒临床医生注意那些患有前列腺癌扩散到肝脏的高风险患者，这一发现对临床管理具有明显的重要性。
