Ability of C-reactive protein to complement multiple prognostic classifiers in men with metastatic castration resistant prostate cancer receiving docetaxel-based chemotherapy

作者：Pond Gregory R; Armstrong Andrew J; Wood Brian A; Leopold Lance; Galsky Matthew D; Sonpavde Guru^*

来源：BJU International, 2012, 110(11B): E461-E468.

DOI：10.1111/j.1464-410X.2012.11148.x

• C-reactive protein
• docetaxel
• metastatic castration resistant prostate cancer
• nomogram
• PCWG-2 clinical subtypes
• risk groups

OBJECTIVE %26lt;br%26gt;Given the recent emergence of C-reactive protein levels as a novel prognostic factor in men with metastatic castration-resistant prostate cancer (mCRPC), we sought to evaluate the independent prognostic ability of C-reactive protein in the context of published prognostic nomograms, risk grouping and disease state models in men receiving docetaxel-based chemotherapy for mCRPC. %26lt;br%26gt;PATIENTS AND METHODS %26lt;br%26gt;A large randomized phase II trial (CS-205) of mCRPC patients who received docetaxel-prednisone + AT-101 (Bcl-2 inhibitor) or docetaxel-prednisone + placebo was analyzed retrospectively (n = 220). %26lt;br%26gt;Overall survival (OS), progression-free survival (PFS) and measures of discriminatory ability were assessed in a hypothesis-generating analysis using Cox regression and concordance probabilities. %26lt;br%26gt;Patients from both treatment groups were combined for this analysis because no significant differences in outcomes were observed. %26lt;br%26gt;Because some factors used in nomograms were not collected or defined differently, risk was estimated based on slightly modified versions of nomograms. %26lt;br%26gt;RESULTS %26lt;br%26gt;C-reactive protein was independently prognostic for OS and PFS (P %26lt;= 0.002) after adjusting for all modeled risk estimates and classifiers. %26lt;br%26gt;C-reactive protein showed a concordance probability of 0.65 for both OS and PFS. %26lt;br%26gt;A 10-factor modified prognostic model based on the TAX327 trial had the greatest observed discrimination ability for OS and PFS (concordance probability = 0.623 and 0.603, respectively) among the modified nomograms or classifiers. %26lt;br%26gt;Adding the TAX327 model risk estimates to C-reactive protein did not substantially increase discrimination ability over C-reactive protein alone. %26lt;br%26gt;CONCLUSIONS %26lt;br%26gt;Current prognostic classifications provide modest discrimination of outcomes in mCRPC receiving docetaxel-based chemotherapy, highlighting the need for improved risk-based models. %26lt;br%26gt;Baseline C-reactive protein appears to be an useful, independent prognostic factor and prospective external validation is warranted.

• 出版日期2012-12