Prognostic model of event‐free survival for patients with androgen‐independent prostate carcinoma

• Published in: Cancer 2005-06, Vol.103 (11), p.2280-2286
• Main Authors: Shulman, Michael J., Benaim, Elie A.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; androgen independent; Androgens - therapeutic use; clinical complications; Cohort Studies; Disease Progression; Disease-Free Survival; Humans; Male; Middle Aged; Models, Biological; Neoplasm Staging; Neoplasms, Hormone-Dependent - diagnosis; Neoplasms, Hormone-Dependent - mortality; Neoplasms, Hormone-Dependent - therapy; Prognosis; prognostic model; prostate carcinoma; Prostate-Specific Antigen - metabolism; Prostatectomy; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - mortality; Prostatic Neoplasms - therapy; Retrospective Studies; Risk Factors; Survival Rate; Treatment Outcome
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.21054

BACKGROUND The current study was conducted to develop a prognostic model of event‐free survival (EFS) in men with androgen‐independent prostate carcinoma (AIPC). METHODS Data from 160 patients diagnosed with AIPC between 1989–2002 were reviewed. No patient had received cytotoxic chemotherapy. A univariate Cox proportional hazards model identified significant predictors of EFS. Recursive partitioning analysis divided these significant variables into prognostic risk groups. The final prognostic model was tested with a Cox proportional hazards model. RESULTS The final prognostic risk model included the presence of metastatic disease at the time of androgen‐independent disease progression (P = 0.040), time to prostate‐specific antigen (PSA) recurrence (P = 0.043), and PSA doubling time (P < 0.01). Three highly independent risk groups were identified. The observed median EFSs were 6.1 months (95% confidence interval [95= CI], 3.4–8.8 months), 33.6 months (95= CI, 25.3–41.9 months), and 96.1 months (95= CI, 57.9–134.3 months) for the low‐risk, intermediate‐risk, and high‐risk groups, respectively. Each risk group was found to be independently predictive of EFS (P < 0.01). Patients who died of prostate carcinoma experienced significantly more clinical events than those who died of other causes (P < 0.01). CONCLUSIONS The prognostic model in the current study stratified patients into three highly significant and independent risk groups for EFS. A detailed PSA history and knowledge of metastatic disease are sufficient to risk‐stratify patients with AIPC. One very unique aspect of this model was that it was developed from a patient cohort that never received chemotherapy. Cancer 2005. © 2005 American Cancer Society. A new prognostic model of event‐free survival stratified men with androgen‐independent prostate carcinoma (AIPC) into three highly significant and independent risk groups. A detailed prostate‐specific antigen history and knowledge of metastatic disease alone are sufficient to stratify patients with AIPC based on risk.