Department of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
Cancer Research Institute Ghent, Ghent University, 9000, Ghent, Belgium.
World J Urol. 2019 Dec;37(12):2565-2571. doi: 10.1007/s00345-018-2449-6. Epub 2018 Aug 22.
To explore the prognostic importance of metastatic volume in a contemporary daily practice cohort of patients with newly diagnosed metastatic hormone-naive prostate cancer (mHNPC) and to develop a pragmatic prognostic model to predict survival for these patients.
Since 2014, 113 patients with newly diagnosed mHNPC were prospectively registered. Statistical analysis was performed using SPSS 25.0™ with two-sided p value < 0.05 indicating statistical significance. Univariate and multivariate cox regression analyses were performed to identify prognostic risk factors. Kaplan-Meier method with log-rank statistics was constructed to analyze difference in survival in the prognostic groups. Model performance was assessed using the Concordance-index (C-index) and cross-validated in R v3.4.1. High-volume mHNPC (HVD) was defined as the presence of visceral metastasis or ≥ 4 bone metastases with ≥ 1 appendicular lesion.
Multivariate analysis identified HVD (p = 0.047) and elevated alkaline phosphatase (ALP) (p = 0.018) as independent prognostic risk factors for overall survival (OS). Consequently, three prognostic groups were created: a good (no risk factors), intermediate (1 risk factor) and poor prognosis group (2 risk factors). Median OS for the good, intermediate and poor prognosis group was not reached, 73 and 20 months (95% CI 9-31 months with p < 0.001 and Correspondence-index of 0.78), respectively.
We developed a pragmatic and qualitative prognostic model consisting of three prognostic risk groups for OS in a daily practice cohort of patients with newly diagnosed mHNPC. Independent prognostic risk factors included in the model were HVD and abnormal ALP.
探索转移性体积在当代新诊断转移性去势敏感性前列腺癌（mHNPC）患者的临床实践队列中的预后重要性，并开发一种实用的预后模型来预测这些患者的生存情况。
自 2014 年以来，前瞻性地登记了 113 例新诊断为 mHNPC 的患者。使用 SPSS 25.0™ 进行统计学分析，双侧 p 值<0.05 表示具有统计学意义。进行单变量和多变量 Cox 回归分析以确定预后危险因素。采用 Kaplan-Meier 方法和对数秩检验分析预后组之间的生存差异。使用一致性指数（C-index）评估模型性能，并在 R v3.4.1 中进行交叉验证。高体积 mHNPC（HVD）定义为存在内脏转移或≥4 个骨转移，且至少有 1 个附肢病变。
多变量分析确定 HVD（p=0.047）和碱性磷酸酶（ALP）升高（p=0.018）是总生存（OS）的独立预后危险因素。因此，创建了三个预后组：良好（无风险因素）、中等（1 个风险因素）和差预后组（2 个风险因素）。良好、中等和差预后组的中位 OS 未达到，分别为 73 和 20 个月（95%CI 9-31 个月，p<0.001，C-index 为 0.78）。
我们开发了一个实用的定性预后模型，由三个新诊断的 mHNPC 患者临床实践队列的 OS 预后风险组组成。纳入模型的独立预后危险因素包括 HVD 和异常的 ALP。
