Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
PeerJ. 2023 Jan 4;11:e14500. doi: 10.7717/peerj.14500. eCollection 2023.
Bone metastasis has been suggested to be a significant impactor on the prognosis of newly diagnosed de novo metastatic hormone-sensitive prostate cancer (mHSPC), and some risk stratification models have been proposed on the basis of this hypothesis. However, the effectiveness of these risk stratification criteria has not been fully evaluated in China. This study aimed to evaluate the effectiveness of the risk stratification models in China.
A total of 140 patients who were newly diagnosed with metastatic prostate cancer followed by primary androgen deprivation-based therapy from January 2008 to June 2021 at our institution were enrolled in this study. The patients were divided into different groups on the basis of high- and low-volume disease (H/LVD) criteria, high-and low-risk disease (H/LRD) criteria, extremity bone metastasis criteria (EBM), and extent of disease (EOD) criteria. The area under the receiver operating characteristic (ROC) curve (AUC) and decision curve analysis (DCA) were used to compare the validity and net benefit of these models. Using the Cox proportional hazards model, we performed univariable and multivariable analyses of the factors influencing overall survival (OS) and the time of progression to metastatic castration-resistant prostate cancer (CRPC).
The median patient age was 72 years. Most patients had a Gleason score ≥8 (102 cases, 72.9%) and clinical T stage >2 (75 cases, 53.6%). The median follow-up time was 25 months (range, 2-95 months). Ninety-two patients progressed to CRPC and fifty-seven patients died during the follow-up. The AUC of OS and CRPC showed that the EOD model had higher validity than the other risk stratification models. DCA shows that the net benefit of the EOD model on OS was better than that of the other risk stratification models. As for CRPC, the net benefit of the EOD model was second only to that of the H/LRD model when the threshold was <0.5; however, when the threshold was >0.5, the EOD model outperformed the other models. The effectiveness of EOD as an independent prognostic variable was verified through univariable and multivariable analyses.
The EOD model yields reasonable risk stratification for use in Chinese mHSPC patients, providing further evidence supporting its role in clinical decision-making.
骨转移被认为对新诊断的初发转移性去势敏感性前列腺癌（mHSPC）的预后有重大影响，在此假说基础上已提出了一些风险分层模型。然而，这些风险分层标准的有效性尚未在中国得到充分评估。本研究旨在评估这些风险分层模型在中国的有效性。
本研究共纳入了 140 例于 2008 年 1 月至 2021 年 6 月在我院接受初治基于去势的一线雄激素剥夺治疗的转移性前列腺癌患者。根据高容量和低容量疾病（H/LVD）标准、高风险和低风险疾病（H/LRD）标准、肢体骨转移（EBM）标准和疾病程度（EOD）标准将患者分为不同的组。使用接受者操作特征（ROC）曲线下面积（AUC）和决策曲线分析（DCA）比较这些模型的有效性和净收益。使用 Cox 比例风险模型对影响总生存（OS）和转移性去势抵抗性前列腺癌（CRPC）进展时间的因素进行单变量和多变量分析。
患者中位年龄为 72 岁。大多数患者的 Gleason 评分≥8（102 例，72.9%）和临床 T 分期>2（75 例，53.6%）。中位随访时间为 25 个月（范围 2-95 个月）。92 例患者进展为 CRPC，57 例患者在随访期间死亡。OS 和 CRPC 的 AUC 显示，EOD 模型的有效性优于其他风险分层模型。DCA 显示，EOD 模型在 OS 上的净收益优于其他风险分层模型。对于 CRPC，当阈值<0.5 时，EOD 模型的净收益仅次于 H/LRD 模型；然而，当阈值>0.5 时，EOD 模型优于其他模型。通过单变量和多变量分析验证了 EOD 作为独立预后变量的有效性。
EOD 模型可对中国 mHSPC 患者进行合理的风险分层，为其在临床决策中的作用提供了进一步的证据支持。
