A novel prognostic model of de novo metastatic hormone-sensitive prostate cancer to optimize treatment intensity

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2024年7月19日

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Hiroshi Fujiwara,
Masashi Kubota,
Yu Hidaka,
Kaoru Ito,
Takashi Kawahara,
Ryoma Kurahashi,
Yuto Hattori,
Yusuke Shiraishi,
Yusuke Hama,
Noriyuki Makita,
Yu Tashiro,
Shotaro Hatano,
Ryosuke Ikeuchi,
Masakazu Nakashima,
Noriaki Utsunomiya,
Yasushi Takashima,
Shinya Somiya,
Kanji Nagahama,
Takeru Fujimoto,
Kosuke Shimizu,
Kazuto Imai,
Takehiro Takahashi,
Takayuki Sumiyoshi,
Takayuki Goto,
Satoshi Morita,
Takashi Kobayashi,
Shusuke Akamatsu

摘要

Background

The treatment and prognosis of de novo metastatic hormone-sensitive prostate cancer (mHSPC) vary. We established and validated a novel prognostic model for predicting cancer-specific survival (CSS) in patients with mHSPC using retrospective data from a contemporary cohort.

Methods

1092 Japanese patients diagnosed with de novo mHSPC between 2014 and 2020 were registered. The patients treated with androgen deprivation therapy and first-generation anti-androgens (ADT/CAB) were assigned to the Discovery (N = 467) or Validation (N = 328) cohorts. Those treated with ADT and androgen-receptor signaling inhibitors (ARSIs) were assigned to the ARSI cohort (N = 81).

Results

Using the Discovery cohort, independent prognostic factors of CSS, the extent of disease score ≥ 2 or the presence of liver metastasis; lactate dehydrogenase levels > 250U/L; a primary Gleason pattern of 5, and serum albumin levels ≤ 3.7 g/dl, were identified. The prognostic model incorporating these factors showed high predictability and reproducibility in the Validation cohort. The 5-year CSS of the low-risk group was 86% and that of the high-risk group was 22%. Approximately 26.4%, 62.7%, and 10.9% of the patients in the Validation cohort defined as high-risk by the LATITUDE criteria were further grouped into high-, intermediate-, and low-risk groups by the new model with significant differences in CSS. In the ARSIs cohort, high-risk group had a significantly shorter time to castration resistance than the intermediate-risk group.

Conclusions

The novel model based on prognostic factors can predict patient outcomes with high accuracy and reproducibility. The model may be used to optimize the treatment intensity of de novo mHSPC.