Skip to main content
SpringerLink
Log in

Importance of metastatic volume in prognostic models to predict survival in newly diagnosed metastatic prostate cancer

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To explore the prognostic importance of metastatic volume in a contemporary daily practice cohort of patients with newly diagnosed metastatic hormone-naive prostate cancer (mHNPC) and to develop a pragmatic prognostic model to predict survival for these patients.

Methods

Since 2014, 113 patients with newly diagnosed mHNPC were prospectively registered. Statistical analysis was performed using SPSS 25.0™ with two-sided p value < 0.05 indicating statistical significance. Univariate and multivariate cox regression analyses were performed to identify prognostic risk factors. Kaplan–Meier method with log-rank statistics was constructed to analyze difference in survival in the prognostic groups. Model performance was assessed using the Concordance-index (C-index) and cross-validated in R v3.4.1. High-volume mHNPC (HVD) was defined as the presence of visceral metastasis or ≥ 4 bone metastases with ≥ 1 appendicular lesion.

Results

Multivariate analysis identified HVD (p = 0.047) and elevated alkaline phosphatase (ALP) (p = 0.018) as independent prognostic risk factors for overall survival (OS). Consequently, three prognostic groups were created: a good (no risk factors), intermediate (1 risk factor) and poor prognosis group (2 risk factors). Median OS for the good, intermediate and poor prognosis group was not reached, 73 and 20 months (95% CI 9–31 months with p < 0.001 and Correspondence-index of 0.78), respectively.

Conclusions

We developed a pragmatic and qualitative prognostic model consisting of three prognostic risk groups for OS in a daily practice cohort of patients with newly diagnosed mHNPC. Independent prognostic risk factors included in the model were HVD and abnormal ALP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Huggins C (1941) Studies on prostatic cancer. Arch Surg 43(2):209. https://doi.org/10.1001/archsurg.1941.01210140043004

    Article  CAS  Google Scholar 

  2. Cornford P, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol 71(4):630–642. https://doi.org/10.1016/j.eururo.2016.08.002

    Article  PubMed  Google Scholar 

  3. James ND, Spears MR, Clarke NW et al (2015) Survival with newly diagnosed metastatic prostate cancer in the docetaxel era: data from 917 patients in the control arm of the STAMPEDE trial (MRC PR08, CRUK/06/019). Eur Urol 67(6):1028–1038. https://doi.org/10.1016/j.eururo.2014.09.032

    Article  PubMed  Google Scholar 

  4. Sweeney CJ, Chen Y-H, Carducci M et al (2015) Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med 373(8):737–746. https://doi.org/10.1056/NEJMoa1503747

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. James ND, Sydes MR, Clarke NW et al (2016) Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet 387(10024):1163–1177. https://doi.org/10.1016/S0140-6736(15)01037-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Fizazi K, Tran N, Fein L et al (2017) Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med. https://doi.org/10.1056/nejmoa1704174

    Article  PubMed  Google Scholar 

  7. James ND, de Bono JS, Spears MR et al (2017) Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med. https://doi.org/10.1056/nejmoa1702900

    Article  PubMed  PubMed Central  Google Scholar 

  8. Halabi S, Lin C-Y, Kelly WK et al (2014) Updated prognostic model for predicting overall survival in first-line chemotherapy for patients with metastatic castration-resistant prostate cancer. J Clin Oncol 32(7):671–677. https://doi.org/10.1200/JCO.2013.52.3696

    Article  PubMed  PubMed Central  Google Scholar 

  9. Van Praet C, Rottey S, Van Hende F et al (2017) Which factors predict overall survival in patients with metastatic castration-resistant prostate cancer treated with abiraterone acetate post-docetaxel? Clin Genitourin Cancer. https://doi.org/10.1016/j.clgc.2017.01.019

    Article  PubMed  Google Scholar 

  10. Smaletz O, Scher HI, Small EJ et al (2002) Nomogram for overall survival of patients with progressive metastatic prostate cancer after castration. J Clin Oncol 20(19):3972–3982. https://doi.org/10.1200/JCO.2002.11.021

    Article  PubMed  Google Scholar 

  11. Armstrong AJ, Garrett-Mayer ES, Yang Y-CO, de Wit R, Tannock IF, Eisenberger M (2007) A contemporary prognostic nomogram for men with hormone-refractory metastatic prostate cancer: a TAX327 study analysis. Clin Cancer Res 13(21):6396–6403. https://doi.org/10.1158/1078-0432.CCR-07-1036

    Article  CAS  PubMed  Google Scholar 

  12. Glass TR, Tangen CM, Crawford ED, Thompson I (2003) Metastatic carcinoma of the prostate: identifying prognostic groups using recursive partitioning. J Urol 169(1):164–169. https://doi.org/10.1097/01.ju.0000042482.18153.30

    Article  CAS  PubMed  Google Scholar 

  13. Gravis G, Boher J-M, Fizazi K et al (2015) Prognostic factors for survival in noncastrate metastatic prostate cancer: validation of the glass model and development of a novel simplified prognostic model. Eur Urol 68(2):196–204. https://doi.org/10.1016/j.eururo.2014.09.022

    Article  PubMed  Google Scholar 

  14. Tait C, Moore D, Hodgson C et al (2014) Quantification of skeletal metastases in castrate-resistant prostate cancer predicts progression-free and overall survival. BJU Int 114(6b):E70–E73. https://doi.org/10.1111/bju.12717

    Article  CAS  PubMed  Google Scholar 

  15. Klaff R, Varenhorst E, Berglund A et al (2016) Clinical presentation and predictors of survival related to extent of bone metastasis in 900 prostate cancer patients. Scand J Urol 50(5):352–359. https://doi.org/10.1080/21681805.2016.1209689

    Article  PubMed  Google Scholar 

  16. Epstein JI, Egevad L, Amin MB et al (2015) The 2014 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma. Am J Surg Pathol 40(2):1. https://doi.org/10.1097/pas.0000000000000530

    Article  Google Scholar 

  17. Mottet N, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71(4):618–629. https://doi.org/10.1016/j.eururo.2016.08.003

    Article  PubMed  Google Scholar 

  18. Efron B, Tibshirani R (1997) Improvements on cross-validation: the. 632 + Bootstrap method. J Am Stat Assoc 92(438):548–560

    Google Scholar 

  19. Buelens S, Poelaert F, Dhondt B et al (2018) Metastatic burden in newly diagnosed hormone-naive metastatic prostate cancer: comparing definitions of CHAARTED and LATITUDE trial. Urol Oncol Semin Orig Investig 36(4):158.e13–158.e20. https://doi.org/10.1016/j.urolonc.2017.12.009

    Article  Google Scholar 

Download references

Funding

This work was supported by the Clinical Research Fund from the Ghent University Hospital.

Author information

Authors and Affiliations

  1. Department of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium

    Sarah Buelens, Elise De Bleser, Bert Dhondt, Wesley Verla, Karel Decaestecker & Nicolaas Lumen

  2. Cancer Research Institute Ghent, Ghent University, 9000, Ghent, Belgium

    Sarah Buelens, Elise De Bleser, Bert Dhondt, Piet Ost & Nicolaas Lumen

  3. Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium

    Piet Ost & Valérie Fonteyne

  4. Department of Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium

    Kathia De Man

  5. Department of Radiology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium

    Chloë Standaert

  6. Department of Medical Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium

    Sylvie Rottey

Authors
  1. Sarah Buelens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elise De Bleser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bert Dhondt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wesley Verla
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karel Decaestecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Piet Ost
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Valérie Fonteyne
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kathia De Man
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chloë Standaert
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sylvie Rottey
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nicolaas Lumen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SB: data collection/management, data analysis, manuscript writing; EDB, KD, PO, VF and SR: data collection/management, manuscript editing; BD: data collection/management; WV: data analysis, manuscript editing; KDM and CS: manuscript editing; NL: protocol/project development, data collection/management, data analysis, manuscript editing.

Corresponding author

Correspondence to Sarah Buelens.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the local ethical committee of Ghent (Belgian registration number B670201420709). 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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buelens, S., De Bleser, E., Dhondt, B. et al. Importance of metastatic volume in prognostic models to predict survival in newly diagnosed metastatic prostate cancer. World J Urol 37, 2565–2571 (2019). https://doi.org/10.1007/s00345-018-2449-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-018-2449-6

Keywords

Search

Navigation