Boegemann Martin, Schlack Katrin, Früchtenicht Lena, Steinestel Julie, Schrader Andres Jan, Wennmann Yvonne, Krabbe Laura-Maria, Eminaga Okyaz
Department of Urology, University of Muenster Medical Center, Muenster, Germany.
Department of Urology, Augsburg Medical Center, Augburg, Germany.
Oncotarget. 2019 Aug 20;10(49):5082-5091. doi: 10.18632/oncotarget.27133.
Therapy resistance remains a serious dilemma in metastatic castration-resistant prostate cancer (mCRPC) with primary or secondary resistance frequently occurring against any given therapy. Available prognostic models for Abiraterone Acetate (AA) are specifically designed for either pre- or post-chemotherapy settings and mostly based on trial datasets not necessarily reflecting real-life. A score of 0-2 (low-risk) is associated with an OS-probability of 80.0% (95%CI: 71.3-90.6) and 50.5% (95%CI: 38.7-66.0) after 1 and 2 years while a score of 3-4 (high risk) is associated with an OS-probability of 35.3% (95%CI: 22.3-55.8) and 5.7% (95%CI: 1.5-21.8), respectively. The bootstrapping survival analysis of the scoring-system revealed a median c-index of 0.80 (IQR: 0.79-0.82). We developed a scoring-system using four real-life parameters 117 mCRPC patients treated with AA either pre- or post-chemotherapy. These parameters were evaluated using COX regression analysis. The scoring-system consists of binary-categorized parameters; when any of these exceeds the given cut-off, one point is added up to a final score ranging between 0-4 points. The final score was stratified by a median threshold of 2 into low- and high-risk groups. We evaluated the discriminative ability of our scoring-system using concordance probability (C-index) and Kaplan-Meier-analysis and applied a 100-times bootstrap for survival analysis. Our study introduces a novel prognostic scoring-system for OS of real-life mCRPC patients receiving AA treatment irrespective of the line of therapy. The scoring-system is simple and can be easily utilized based on PSA and LDH values, neutrophil to lymphocyte ratio, and ECOG performance status.
治疗耐药仍然是转移性去势抵抗性前列腺癌（mCRPC）中的一个严重难题，对任何给定治疗方案，原发性或继发性耐药都经常出现。醋酸阿比特龙（AA）现有的预后模型是专门为化疗前或化疗后情况设计的，且大多基于试验数据集，不一定能反映现实情况。评分0 - 2分（低风险）与1年和2年后的总生存期概率分别为80.0%（95%CI：71.3 - 90.6）和50.5%（95%CI：38.7 - 66.0）相关，而评分3 - 4分（高风险）分别与总生存期概率35.3%（95%CI：22.3 - 55.8）和5.7%（95%CI：1.5 - 21.8）相关。该评分系统的自抽样生存分析显示，中位c指数为0.80（IQR：0.79 - 0.82）。我们使用四个现实生活参数为117例接受化疗前或化疗后AA治疗的mCRPC患者开发了一个评分系统。这些参数通过COX回归分析进行评估。该评分系统由二元分类参数组成；当其中任何一个超过给定阈值时，加1分，最终得分范围为0 - 4分。最终得分通过中位数阈值2分为低风险和高风险组。我们使用一致性概率（C指数）和Kaplan - Meier分析评估了我们评分系统的判别能力，并应用100次自抽样进行生存分析。我们的研究为接受AA治疗的现实生活中的mCRPC患者的总生存期引入了一种新的预后评分系统，无论治疗线数如何。该评分系统简单，基于PSA和LDH值、中性粒细胞与淋巴细胞比值以及ECOG体能状态即可轻松使用。
