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A 3-variable prognostic score (3-PS) for overall survival prediction in metastatic castration-resistant prostate cancer treated with 223Radium-dichloride

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Abstract

Objective

In mCRPC patients treated with 223Ra, a major issue is the validation of reliable prognostic and predictive biomarkers to maximize clinical benefit and minimize toxicities and costs. Bearing in mind how changes in tALP did not meet statistical requirements as surrogate marker for survival, aim of this single-center retrospective study was to characterize the prognostic and predictive role of baseline clinical variables associated with overall survival in patients receiving 223Ra treatment.

Methods

92 consecutive CRPC patients with symptomatic bone metastases receiving 223Ra treatment were included. Available baseline clinical data relevant to the survival analysis were retrospectively collected. The primary end-point of the study was overall survival, which was established from the first 223Ra administration until date of death from any cause.

Results

Median follow-up time from the first 223Ra administration was 6 months (range 1–31 months). The univariate analysis evaluating the prognostic value of all baseline clinical variables showed that patients’ weight, BMI, ECOG PS, Hb and tALP values were independently associated with OS. On multivariable analysis only baseline Hb value and ECOG PS remained significantly correlated with OS. To determine reliable baseline predictive factors for survival in patients receiving 223Ra treatment, we produced a predictive score. We tried all possible variable combinations, and found that the best score was obtained by combining baseline ECOG PS with Hb < 12 g/dl and PSA ≥ 20 ng/ml. This resulted in a score ranging from 0 to 4, with AUC 78.4% (p < 0.001).

Conclusions

We propose a multidimensional clinical evaluation to select those mCRPC subjects suitable to receive the maximum benefit from 223Ra treatment.

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Authors and Affiliations

  1. Department of Radiological Sciences, Oncology and Anatomo-Pathology, “Sapienza” University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy

    Viviana Frantellizzi, Giulia Anna Follacchio & Giuseppe De Vincentis

  2. Angio-Cardio-Thoracic Pathophisiology and Imaging, “Sapienza” University of Rome, Rome, Italy

    Viviana Frantellizzi

  3. Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Piazzale Aldo Moro, 5, 00161, Rome, Italy

    Alessio Farcomeni

  4. Department of Medical Physics, Azienda Ospedaliera Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy

    Massimiliano Pacilio

  5. Department of Molecular Medicine, “Sapienza” University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy

    Rosanna Pellegrini

  6. Department of Sciences and Medico-Surgical Biotechnologies, “Sapienza” University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy

    Roberto Pani

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  1. Viviana Frantellizzi
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  2. Alessio Farcomeni
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  3. Giulia Anna Follacchio
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  7. Giuseppe De Vincentis
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Corresponding author

Correspondence to Viviana Frantellizzi.

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No potential conflicts of interest were disclosed.

Human and animal rights statement

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all patients.

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Frantellizzi, V., Farcomeni, A., Follacchio, G.A. et al. A 3-variable prognostic score (3-PS) for overall survival prediction in metastatic castration-resistant prostate cancer treated with 223Radium-dichloride. Ann Nucl Med 32, 142–148 (2018). https://doi.org/10.1007/s12149-017-1228-6

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  • DOI: https://doi.org/10.1007/s12149-017-1228-6

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