The number of risk factors is the strongest predictor of prostate cancer mortality: multi-institutional outcomes of an extreme-risk prostate cancer cohort

• Autores: A. Gómez-Iturriaga, Á. Cabeza, Jorge Rafael Pastor Peidro, J. Jové Teixidó, M. Casaña Giner, A.G. Caamaño, J.L. Mengual Cloquell, I. Henríquez, Julia Luisa Muñoz García, Asunción Hervás Morón, Carmen González San Segundo
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 18, Nº. 10, 2016, págs. 1026-1033
• Idioma: inglés
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• Resumen

  • Purpose To report treatment outcomes in a cohort of extreme-risk prostate cancer patients and identify a subgroup of patients with worse prognosis.

    Materials and methods Extreme-risk prostate cancer patients were defined as patients with at least one extreme-risk factor: stage cT3b–cT4, Gleason score 9–10 or PSA > 50 ng/ml; or patients with 2 or more high-risk factors: stage cT2c–cT3a, Gleason 8 and PSA > 20 ng/ml. Overall survival (OS), cause-specific survival (CSS), clinical-free survival (CFS), and biochemical non-evidence of disease (bNED) survival are the four outcomes of interest in a population of 1341 patients.

    Results With a median follow-up of 71.5 months, 5- and 10-year bNED survival, CFS, CSS and OS for the entire cohort were 77.1 % and 57.0, 89.2 and 78.9 %, 97.4 and 93.6 %, and 92.0 and 71.3 %, respectively. On multivariate analysis, PSA and clinical stage were associated with bNED survival. PSA and Gleason score predicted for CFS, whereas only Gleason score predicted for OS. When a simplified model was performed using the “number of risk factors” variable, this model provided the best distinction between patients with ≥2 extreme-risk factors and patients with 2 high-risk factors, showing a hazard ratio (HR) of 1.737 (p = 0.0003) for bNED survival, HR 1.743 (p = 0.0448) for OS and an HR of 3.963 (p = 0.0039) for the CSS endpoint.

    Conclusions Patients presenting at diagnosis with two extreme-risk criteria have almost fourfold higher risk for prostate cancer mortality. Such patients should be considered for more aggressive multimodal treatments.