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. (23rd July 2021)

• Record Type: Journal Article
• Authors: Tsuzuki, Shunsuke; Kawano, Shota; Fukuokaya, Wataru; Mori, Keiichiro; Nishikawa, Hideomi; Tashiro, Kojiro; Watanabe, Daisuke; Uchimoto, Taizo; Nishimura, Kazuki; Yano, Yusuke; Murakami, Masaya; Koike, Yusuke; Hata, Kenichi; Koide, Haruhisa; Miki, Jun; Abe, Hirokazu; Yamada, Hiroki; Naruoka, Takehito; Sugaya, Shingo; Kimura, Takahiro; Tomita, Masayuki; Nakajo, Hiroshi; Egawa, Shin
• Is Part Of: Japanese journal of clinical oncology. Volume 51:Number 11(2021)
• Page Start: 1665
• Page End: 1671
• Publication Date: 2021-07-23
• Subjects: alkaline phosphatase -- Gleason score -- lactate dehydrogenase -- low-risk metastatic hormone-sensitive prostate cancer -- survival; Oncology -- Periodicals; Cancer -- Periodicals; 616.994005
• DOI: 10.1093/jjco/hyab115
• Languages: English
• ISSNs: 0368-2811

Abstract

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. Abstract : Assessment of Gleason score, ALP, and LDH can predict worse survivors in low-risk mHSPC patients.