Prognostic Model Predicting Metastatic Castration-Resistant Prostate Cancer Survival in Men Treated With Second-Line Chemotherapy
Prognostic Model Predicting Metastatic Castration-Resistant Prostate Cancer Survival in Men Treated With Second-Line Chemotherapy
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DOI：
10.1093/jnci/djt280
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发表时间：
2013-11-01
影响因子：
10.3
通讯作者：
Sartor, Oliver
中科院分区：
文献类型：
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作者：
Halabi, Susan;Lin, Chen-Yen;Sartor, Oliver
已经在接受一线化疗的转移性去势抵抗性前列腺癌（mCRPC）男性患者中开发并验证了几种总生存期（OS）的预后模型。我们试图开发和验证一个预测模型，以预测一线化疗后疾病进展并被选择接受二线化疗的男性的OS，使用了一线化疗后疾病进展的mCRPC男性III期试验（TROPIC试验）的数据。TROPIC被随机分为训练集（n 507）和测试集（n 248）。另一个数据集包括488名既往接受多西他赛治疗的男性（多西他赛试验），用于外部验证。自适应最小绝对收缩和选择算子选择9个影响OS预后的因素，根据回归系数计算预后评分。使用时间依赖性曲线下面积（tAUC）在测试和验证集上评估模型的预测准确性，最终模型中的9个预后变量为东部肿瘤协作组体力状态、自上次多西他赛使用以来的时间、可测量疾病、内脏疾病的存在、疼痛、激素使用的持续时间、血红蛋白、前列腺特异性抗原和碱性磷酸酶。该模型的tAUC在测试集和验证集分别为0.73（95%置信区间[CI] 0.72 - 0.74）和0.70（95% CI 0.68 - 0.72）。开发并外部验证了多西他赛治疗后、二线化疗、mCRPC背景下的OS预后模型。该模型结合了新的预后因素，可用于为个体患者提供预测概率，并根据患者的预后选择患者参加临床试验。需要前瞻性验证。
Several prognostic models for overall survival (OS) have been developed and validated in men with metastatic castration-resistant prostate cancer (mCRPC) who receive first-line chemotherapy. We sought to develop and validate a prognostic model to predict OS in men who had progressed after first-line chemotherapy and were selected to receive second-line chemotherapy.Data from a phase III trial in men with mCRPC who had developed progressive disease after first-line chemotherapy (TROPIC trial) were used. The TROPIC was randomly split into training (n 507) and testing (n 248) sets. Another dataset consisting of 488 men previously treated with docetaxel (SPARC trial) was used for external validation. Adaptive least absolute shrinkage and selection operator selected nine prognostic factors of OS. A prognostic score was computed from the regression coefficients. The model was assessed on the testing and validation sets for its predictive accuracy using the time-dependent area under the curve (tAUC).The nine prognostic variables in the final model were Eastern Cooperative Oncology Group performance status, time since last docetaxel use, measurable disease, presence of visceral disease, pain, duration of hormonal use, hemoglobin, prostate specific antigen, and alkaline phosphatase. The tAUCs for this model were 0.73 (95% confidence interval [CI] 0.72 to 0.74) and 0.70 (95% CI 0.68 to 0.72) for the testing and validation sets, respectively.A prognostic model of OS in the postdocetaxel, second-line chemotherapy, mCRPC setting was developed and externally validated. This model incorporates novel prognostic factors and can be used to provide predicted probabilities for individual patients and to select patients to participate in clinical trials on the basis of their prognosis. Prospective validation is needed.