Prognostic model with alkaline phosphatase, lactate dehydrogenase and presence of Gleason pattern 5 for worse overall survival in low-risk metastatic hormone-sensitive prostate cancer.

Abstract

BACKGROUND:

Randomized trials showed the survival benefits of the combined use of androgen receptor axis-targeted agents with androgen deprivation therapy in metastatic hormone-sensitive prostate cancer (mHSPC), regardless of the risk. However, treating patients with low-risk mHSPC with such intensive treatment is still debatable.

METHODS:

This retrospective study included 155 low-risk patients among 467 mHSPC patients treated in our affiliated institutions. The association between predictive factors and treatment outcomes was estimated using the Kaplan-Meier method and log-rank test. Predictive factors for castration resistant prostate cancer (CRPC)-free survival were investigated using Cox regression analyses.

RESULTS:

During the median follow-up of 39 months, 38.7% of patients developed CRPC and 14.2% died. In the multivariate analyses, a presence of Gleason pattern 5 (hazard ratio [HR] 2.04), high alkaline phosphatase (HR 1.007) and high lactate dehydrogenase (HR 1.009) were significant predictive factors for shorter CRPC-free survival. Finally, 155 patients were stratified into favorable- and unfavorable-risk groups based on the numbers of the predictive factors. The overall survival (OS) in the unfavorable-risk group (total scores: 2-3) was significantly worse than that of the favorable-risk group (total score: 0-1) (P = 0.02). This prognostic model was assessed with 50 low-risk mHSPC patients from the external validation dataset and found both the time to CRPC, and the OS in the unfavorable-risk group was significantly worse than that of the favorable-risk group (P < 0.01).

CONCLUSIONS:

The combination of Gleason pattern 5, high alkaline phosphatase and lactate dehydrogenase can predict those with worse OS in low-risk mHSPC patients.

• Authors: Shunsuke Tsuzuki, Shota Kawano, Wataru Fukuokaya, Keiichiro Mori, Hideomi Nishikawa, Kojiro Tashiro, Daisuke Watanabe, Taizo Uchimoto, Kazuki Nishimura, Yusuke Yano, Masaya Murakami, Yusuke Koike, Kenichi Hata, Haruhisa Koide, Jun Miki, Hirokazu Abe, Hiroki Yamada, Takehito Naruoka, Shingo Sugaya, Takahiro Kimura, Masayuki Tomita, Hiroshi Nakajo, Shin Egawa
• Journal: Japanese journal of clinical oncology (Jpn J Clin Oncol) Vol. 51 Issue 11 Pg. 1665-1671 (Nov 01 2021) ISSN: 1465-3621 [Electronic] England
• PMID: 34296282 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Androgen Antagonists
• Hormones
• L-Lactate Dehydrogenase
• Alkaline Phosphatase

Topics

• Alkaline Phosphatase
• Androgen Antagonists (therapeutic use)
• Hormones
• Humans
• L-Lactate Dehydrogenase
• Male
• Prognosis
• Prostatic Neoplasms (drug therapy)
• Prostatic Neoplasms, Castration-Resistant (drug therapy)
• Retrospective Studies