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An end of life prognostic score for patients with metastatic prostate cancer receiving palliative radiotherapy

Date

09 Oct 2016

Session

Poster display

Presenters

John Donaghy

Citation

Annals of Oncology (2016) 27 (6): 455-461. 10.1093/annonc/mdw384

Authors

J. Donaghy1, A. Lopes2, M. Ali1, R. Davda1, J. Mascoll1, J. Forgenie1, S. Howard1, U. McGovern1, H. Payne3, A. Mitra1, M. Linch3

Author affiliations

  • 1 Oncology, University College London Hospital, N1 2BU - London/GB
  • 2 Oncology, Cancer Research UK & University College London Cancer Trials Centre, London/GB
  • 3 Oncology, UCL/UCLH NIHR Biomedical Research Centre, N1 2BU - London/GB
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Background

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.

Methods

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 

Results

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%).

Conclusions

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

Not applicable.

Legal entity responsible for the study

University College London Hospitals

Funding

UCL/UCLH-NIHR Biomedical Research Centre. M.L is also supported by Cancer Research UK and Prostate Cancer Foundation.

Disclosure

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.

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