Prognostic Model for Predicting Survival in Men With Hormone-Refractory Metastatic Prostate Cancer

TLDR

The study develops and validates a prognostic model to predict overall survival in metastatic hormone‑refractory prostate cancer patients and to stratify them for phase III trials. The authors built a multivariable proportional hazards model from pretreatment factors in 1,101 patients pooled from six C&L Group B protocols, assessed discrimination with ROC AUC, calibrated predictions, classified patients into four risk groups, and validated the model on an independent dataset. The model achieved an AUC of 0.68, showed good agreement between observed and predicted survival, and distinguished four risk groups with median survival times ranging from 7.5 to 27.2 months, closely matching predicted survival times.

Abstract

To develop and validate a model that can be used to predict the overall survival probability among metastatic hormone-refractory prostate cancer patients (HRPC).Data from six Cancer and Leukemia Group B protocols that enrolled 1,101 patients with metastatic hormone-refractory adenocarcinoma of the prostate during the study period from 1991 to 2001 were pooled. The proportional hazards model was used to develop a multivariable model on the basis of pretreatment factors and to construct a prognostic model. The area under the receiver operating characteristic curve (ROC) was calculated as a measure of predictive discrimination. Calibration of the model predictions was assessed by comparing the predicted probability with the actual survival probability. An independent data set was used to validate the fitted model.The final model included the following factors: lactate dehydrogenase, prostate-specific antigen, alkaline phosphatase, Gleason sum, Eastern Cooperative Oncology Group performance status, hemoglobin, and the presence of visceral disease. The area under the ROC curve was 0.68. Patients were classified into one of four risk groups. We observed a good agreement between the observed and predicted survival probabilities for the four risk groups. The observed median survival durations were 7.5 (95% confidence interval [CI], 6.2 to 10.9), 13.4 (95% CI, 9.7 to 26.3), 18.9 (95% CI, 16.2 to 26.3), and 27.2 (95% CI, 21.9 to 42.8) months for the first, second, third, and fourth risk groups, respectively. The corresponding median predicted survival times were 8.8, 13.4, 17.4, and 22.80 for the four risk groups.This model could be used to predict individual survival probabilities and to stratify metastatic HRPC patients in randomized phase III trials.