To develop and validate a prognostic risk model for high-risk metastatic hormone-sensitive prostate cancer (mHSPC) patients treated with upfront abiraterone acetate (ABI).
This retrospective multicenter study involved 233 high-risk mHSPC patients who received upfront ABI, developed by three academic centers. The model was externally validated with an independent cohort of 282 patients. To identify independent prognostic factors for second progression-free survival (PFS2) and develop the best-fitted model, Cox proportional hazards regression, followed by the Akaike information criterion, was used. Patients were categorized into three groups based on their risk scores. PFS2 and overall survival (OS) were evaluated according to the risk groups in the discovery and validation cohorts.
The median age was 72 (range 51-89) years, with a median follow-up duration of 27 months. Independent factors linked to PFS2 included an Eastern Cooperative Oncology Group performance status ≥2, a primary Gleason score of 5, an extent of disease score of ≥3 or liver metastasis, and lactate dehydrogenase >220 U/L. Median PFS2 for favorable-, intermediate-, and poor-risk groups were not reached, 43 months, and 16 months, respectively. The median OS was 29 months in the poor-risk group, whereas it was not reached in the favorable- and intermediate-risk groups. The 2-year OS rates in the favorable-, intermediate- and poor-risk groups were 94.5%, 80.1%, and 60.3%, respectively. The validation cohort confirmed the risk model's relationship with PFS2 and OS. The median PFS2 and OS in the high-risk group were 21 months and 32 months, respectively.
Our prognostic model, including five clinical factors, is useful for patient care and treatment selection in high-risk mHSPC patients treated with ADT plus ABI. The developed model could provide more accurate information, guide treatment decisions, or classify patients in future clinical trials.
The Prostate. 2024 Sep 30 [Epub ahead of print]
Shintaro Narita, Takafumi Yanagisawa, Shingo Hatakeyama, Kenichi Hata, Kazutoshi Fujita, Takashi Ueda, Toshikazu Tanaka, Shinya Maita, Shuji Chiba, Hiromi Sato, Yuya Sekine, Mizuki Kobayashi, Soki Kashima, Ryohei Yamamoto, Kazuyuki Numakura, Mitsuru Saito, Koichiro Takayama, Katsumi Okane, Toshiya Ishida, Yohei Horikawa, Teruaki Kumazawa, Jiro Shimoda, Ikuya Iwabuchi, Takehiro Suzuki, Osamu Ukimura, Takahiro Kimura, Chikara Ohyama, Kyoko Nomura, Tomonori Habuchi
Department of Urology, Akita University Graduate School of Medicine, Akita, Japan., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Department of Urology, Kindai University, Faculty of Medicine, Osakasayama, Osaka, Japan., Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto‑City, Kyoto, Japan., Department of Urology, Aomori Prefectural Hospital, Aomori, Japan., Department of Urology, Iwate Prefectural Isawa Hospital, Mizusawa, Japan., Department of Urology, Yuri Kumiai General Hospital, Honjo, Japan., Department of Urology, Yokote City Hospital, Yokote, Japan., Department of Urology, Akita Kosei Medical Center, Akita, Japan., Department of Urology, Akita City Hospital, Akita, Japan., Department of Urology, Akita Red Cross Hospital, Akita, Japan., Department of Urology, Omagari Kosei Medical Center, Daisen, Japan., Department of Urology, Hiraka General Hospital, Yokote, Japan., Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan.