A prognostic index model for predicting overall survival in patients with metastatic castration-resistant prostate cancer treated with abiraterone acetate after docetaxel
Open Access
- 18 December 2015
- journal article
- research article
- Published by Elsevier BV
- Vol. 27 (3), 454-460
- https://doi.org/10.1093/annonc/mdv594
Abstract
Few prognostic models for overall survival (OS) are available for patients with metastatic castration-resistant prostate cancer (mCRPC) treated with recently approved agents. We developed a prognostic index model using readily available clinical and laboratory factors from a phase III trial of abiraterone acetate (hereafter abiraterone) in combination with prednisone in post-docetaxel mCRPC. Baseline data were available from 762 patients treated with abiraterone–prednisone. Factors were assessed for association with OS through a univariate Cox model and used in a multivariate Cox model with a stepwise procedure to identify those of significance. Data were validated using an independent, external, population-based cohort. Six risk factors individually associated with poor prognosis were included in the final model: lactate dehydrogenase > upper limit of normal (ULN) [hazard ratio (HR) = 2.31], Eastern Cooperative Oncology Group performance status of 2 (HR = 2.19), presence of liver metastases (HR = 2.00), albumin ≤4 g/dl (HR = 1.54), alkaline phosphatase > ULN (HR = 1.38) and time from start of initial androgen-deprivation therapy to start of treatment ≤36 months (HR = 1.30). Patients were categorized into good (n = 369, 46%), intermediate (n = 321, 40%) and poor (n = 107, 13%) prognosis groups based on the number of risk factors and relative HRs. The C-index was 0.70 ± 0.014. The model was validated by the external dataset (n = 286). This analysis identified six factors used to model survival in mCRPC and categorized patients into three distinct risk groups. Prognostic stratification with this model could assist clinical practice decisions for follow-up and monitoring, and may aid in clinical trial design. NCT00638690.Keywords
This publication has 33 references indexed in Scilit:
- Alpha Emitter Radium-223 and Survival in Metastatic Prostate CancerNew England Journal of Medicine, 2013
- Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 studyThe Lancet Oncology, 2012
- Increased Survival with Enzalutamide in Prostate Cancer after ChemotherapyNew England Journal of Medicine, 2012
- Abiraterone and Increased Survival in Metastatic Prostate CancerNew England Journal of Medicine, 2011
- Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trialThe Lancet, 2010
- Sipuleucel-T Immunotherapy for Castration-Resistant Prostate CancerNew England Journal of Medicine, 2010
- The Importance of Identifying and Validating Prognostic Factors in OncologySeminars in Oncology, 2010
- Reporting performance of prognostic models in cancer: a reviewBMC Medicine, 2010
- Prognostic Factors for Overall Survival in Patients With Metastatic Renal Cell Carcinoma Treated With Vascular Endothelial Growth Factor–Targeted Agents: Results From a Large, Multicenter StudyJournal of Clinical Oncology, 2009
- Prostate Cancer: A Practical Approach to Current Management of Recurrent DiseaseMayo Clinic Proceedings, 2007