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Corrected area under prostate-specific antigen (PSA) curve and PSA half-time dynamics during chemotherapy. A new prognostic classification for hormone-refractory prostate cancer (HRPC) patients

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

Autori: P. Beuzeboc, E. Banu, Y. Goubely Brewer, A. Banu, M. Zerbib, T. Flam, M. Peyromaure, F. Scotte, J. M. Andrieu and S. Oudard

Editorial: Poster presentation. Abstract 4641. J Clin Oncol (supplement) 2005;23(16S):413s., 2005.


Background: The PSA half-time (PSA HT) dynamics and corrected area under PSA curve (PSA c-AUC) during chemotherapy (CT) predict overall survival (OS) probability among metastatic HRPC patients (ASCO 2003, abstract 1673; ASCO 2004, abstract 9579). This has motivated the search of a new prognostic classification to identify these patients (pts) at risk, with a poor outcome. The manner in which these parameters were combined could have a major survival impact. Methods: Based on their PSA c-AUC values (< 60 or 60 ng/mL) and PSA HT categories [initial progressers (IP), late progressers (LP) and responders (R)], a new prognostic classification was defined (Table). Analysis was done according to the OS as primary end point, stratified by first-line CT regimen. Log-rank test was used to determine the equality of the groups over the survival distribution estimates. Results: Two hundred-eighteen metastatic HRPC pts treated with docetaxel (77%) or mitoxantrone (23%) based CT were included in this exploratory analysis. Pts characteristics: median age 68 years (range 51–91 years), median PSA follow-up duration of 26.8 months (range 2–184 months). The 3-year OS for the entire cohort was 26% with a median of 20 months [95% confidence interval (CI) 17.5–22.5 months)]; 137 (73%) pts have died. Our classification identified three major risk groups with predicted 3-year survival rates of 45%, 28% and 16% (Table). There was an significant difference in OS (log-rank, P=0.00003) according to prognostic groups. Conclusions: The PSA c-AUC and PSA HT are predictive factors for overall survival independently of chemotherapy regimen. Combination of both parameters is more powerful, being capable to stratify patients according to survival probabilities. Such model could assist in assessing the results of newer therapies, by comparing predicted survival to achieved survival.

Cuvinte cheie: cancer de prostate, aria sub curba, PSA, timp de injumatatire, supravietuire // prostate cancer, area under the curve, PSA, half-life, survival