Radiotherapy can provide symptomatic relief in the palliative
management of patients with metastatic prostate cancer (mPC) however this would not usually be offered to those patients with a prognosis of less than three months. This study aims to determine the predictive value of a set of routinely collected parameters with respect to prognosis in these patients.
A retrospective analysis of 101 patients with metastatic prostate
cancer who received palliative radiotherapy between 2009 and 2012 was
performed. The variables measured were haemoglobin (Hb;g/dl), age (years), prostate-specific antigen (PSA;ng/ml), PSA doubling time (months),
neutrophil:lymphocyte ratio (NLR) and albumin (g/L). Each variable was
measured within the 3 months preceding radiotherapy. The dataset was split randomly into a training set (n = 59) and a validation set (n = 29). Overall survival univariate cox models were performed in the training set using each of the variables above. Those variables with a p-value
Hb, age, NLR ratio and albumin were associated with survival in the
training set. The multivariate cox model identified that high Hb values (HR: 0.90 [95%CI: 0.72; 1.11]) and albumin values (0.89 [95%CI: 0.83; 0.95]) were associated with decreased risk of death and increase in age (1.04 [95%CI: 1.00; 1.08]) and NLR (1.02 [95%CI: 0.92; 1.12]) were associated with higher risk of death. A prognostic score nomogram was derived from this model with a prognostic performance, measured using area under ROC curve, of 86% (95%CI 73%; 100%).
This prognostic score allows for accurate prediction of survival in patients with mPC and could be a valuable tool to assist routine clinical decisions surrounding radiotherapy, chemotherapy and enrollment in clinical trials with respect to the end-of-life setting.
Clinical trial identification
Legal entity responsible for the study
University College London Hospitals
UCL/UCLH-NIHR Biomedical Research Centre. M.L is also supported by Cancer Research UK and Prostate Cancer Foundation.
H. Payne: Educational grants from Astellas and Jansen. M. Linch: Educational and research grants from Bayer, Sanofi, BMS. All other authors have declared no conflicts of interest.