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Corrected area under serum PSA curve as a predictor of survival after chemotherapy for hormone-refractory prostate cancer (HRPC) patients

Domenii publicaţii > Ştiinţe medicale + Tipuri publicaţii > Articol în volumul unei conferinţe

Autori: S. Oudard, E. Banu, N. Thiounn, M. Zerbib, T. Flam, B. Debré, A. Banu, F. Scotté and J.-M. M. Andrieu

Editorial: Poster presentation. Abstract 9579. J Clin Oncol (supplement) 2004;22(14S):850., 2004.


Background: The rate of serum prostate-specific antigen (PSA) decline during chemotherapy can be used to predict overall survival probability among HRPC patients (pts). Using a pharmacokinetic principle, we were able to define a new potential predictive factor: Corrected Area Under Serum PSA Curve. Methods: We conducted a retrospective analysis to validate the PSA c-AUC concept, defined as total Area Under serum PSA Curve (PSA AUC) value per unit of time, on all known PSA values. The trapezoidal and Simpson’s rules were used to calculate the PSA AUC. Patients had regular PSA evaluations from primary diagnosis until death or last evaluation. Based on their PSA c-AUC values, patients were analysed according to the overall survival as primary endpoint. Results: Two hundred twenty HRPC patients treated with docetaxel or mitoxantrone based chemotherapy were included in this analysis. Patients characteristics: median age 69 years (range 51–91 years), median PSA follow-up duration of 19.9 months (range 1–169 months). Median PSA c-AUC was 63 ng/mL (range 0.2–2985 ng/mL). The median survival for the entire group was 18.4 months (95% C.I 15.7–21.1 months); 120 pts (57%) have died. There was an significant difference in overall survival in favour of the low PSA c-AUC level (< 60 ng/mL) group compared with the high PSA c-AUC level ( 60 ng/mL) group. The median survival were 21.6 months (95% C.I 18.2–25.1 months) vs. 13.7 months (95% C.I. 10.7–16.8 months), (p=0.0005), respectively. In a univariate analysis significant interactions with survival was identified after adjustment according to treatment arm, for Gleason score (p=0.04), PSA c-AUC (p=0.01) and hormono-sensitivity duration (p=0.04). Only PSA c-AUC variable remained significant in the multivariate analysis. Conclusions: The PSA c-AUC value is a potent predictive factor for overall survival independent of treatment regimen. This parameter may play a significant role in the treatment management of HRPC patients and could be used in prospective clinical trials.

Cuvinte cheie: PSA aria sub curba, supravietuire, cancer de prostata // PSA area under curve, survival, prostate cancer