Introduction
Castration-sensitive metastatic prostate cancer is heterogeneous. Our objective is
to identify metastatic prostate cancer phenotypes and their prognostic impact on survival.
Materials and Methods
The National Cancer Database was queried. The Surveillance, Epidemiology, and End
Results database was used for validation. Patterns were split into: nonregional lymph
node, bone only, and visceral (any brain/liver/lung). Hazard ratios (HR) with 95%
confidence intervals (CI) were calculated for the univariate and multivariate Cox
proportional hazards regression models, odds ratios were calculated, Kaplan-Meier
curves were generated, and a nomogram of the multivariate regression model was created.
Results
The training set included 13,818 men; bone only was most common (n = 11,632, 84.2%),
then nonregional lymph node (n = 1388, 10.0%), and any visceral (brain/liver/lung;
n = 798, 5.8%). Risk of death was increased by metastases to a visceral organ versus
nonregional lymph node (HR = 2.26; 95% CI [2.00, 2.56]), bone only metastases versus
nonregional lymph node (HR = 1.57; 95% CI [1.43, 1.72]), T-stage 4 versus 1 (HR = 1.27;
95% CI [1.17, 1.36]), Grade Group 5 versus 1 (HR = 1.93; 95% CI [1.61, 2.31]), PSA
> 20 ng/mL versus < 10 ng/mL (HR = 1.32; 95% CI [1.23, 1.42]), and age ≥ 80 versus
< 50 (HR = 1.96; 95% CI [1.69, 2.29]). On internal validation, the model had C-indices
20.5%, 22.7%, and 14.6% higher than the current staging system for overall survival,
1-year, and 5-year survival, respectively.
Conclusion
We developed and validated prognostic metastatic prostate cancer phenotypes that can
assist risk stratification to potentially personalize therapy. Our nomogram (https://tinyurl.com/prostate-met) may be used to predict survival.
Keywords
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Article info
Publication history
Published online: February 23, 2022
Accepted:
February 19,
2022
Received in revised form:
February 15,
2022
Received:
August 15,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
