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Prognostic Factors for Survival in Noncastrate Metastatic Prostate Cancer: Validation of the Glass Model and Development of a Novel Simplified Prognostic Model

Gwenaelle Gravis 1 Jean-Marie Boher 1, 2 Karim Fizazi 3, 4, 5 Florence Joly 6, 7 Franck Priou 8 Patricia Marino 1, 2 Igor Latorzeff 9 Remy Delva 10 Ivan Krakowski 11 Brigitte Laguerre 12 Jochen Walz 1 Fréderic Rolland 13 Christine Théodore 14 Gael Deplanque 15 Jean-Marc Ferrero 16 Damien Pouessel 17 Loïc Mourey 18 Philippe Beuzeboc 19 Sylvie Zanetta 20 Muriel Habibian 21 Jean-François Berdah 22 Jerome Dauba 23 Marjorie Baciuchka 24 Christian Platini 25 Claude Linassier 26 Jean-Luc Labourey 27 Jean Pascal Machiels 28 Claude El Kouri 29 Alain Ravaud 30 Etienne Suc 31 Jean-Christophe Eymard 32 Ali Hasbini 33 Guilhem Bousquet 34 Michel Soulie 35 Stéphane Oudard 36, 37 
5 Oncologie génito-urinaire
Département de médecine oncologique [Gustave Roussy]
Abstract : Background: The Glass model developed in 2003 uses prognostic factors for noncastrate metastatic prostate cancer (NCMPC) to define subgroups with good, intermediate, and poor prognosis. Objective: To validate NCMPC risk groups in a more recently diagnosed population and to develop a more sensitive prognostic model. Design, setting, and participants: NCMPC patients were randomized to receive continuous androgen deprivation therapy (ADT) with or without docetaxel in the GETUG-15 phase 3 trial. Potential prognostic factors were recorded: age, performance status, Gleason score, hemoglobin (Hb), prostate-specific antigen, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), metastatic localization, body mass index, and pain. Outcome measurements and statistical analysis: These factors were used to develop a new prognostic model using a recursive partitioning method. Before analysis, the data were split into learning and validation sets. The outcome was overall survival (OS). Results and limitations: For the 385 patients included, those with good (49%), intermediate (29%), and poor (22%) prognosis had median OS of 69.0, 46.5 and 36.6 mo (p=0.001), and 5-yr survival estimates of 60.7%, 39.4%, and 32.1%, respectively (p=0.001). The most discriminatory variables in univariate analysis were ALP, pain intensity, Hb, LDH, and bone metastases. ALP was the strongest prognostic factor in discriminating patients with good or poor prognosis. In the learning set, median OS in patients with normal and abnormal ALP was 69.1 and 33.6 mo, and 5-yr survival estimates were 62.1% and 23.2%, respectively. The hazard ratio for ALP was 3.11 and 3.13 in the learning and validation sets, respectively. The discriminatory ability of ALP (concordance [C] index 0.64, 95% confidence interval [CI] 0.58-0.71) was superior to that of the Glass risk model (C-index 0.59, 95% CI 0.52-0.66). The study limitations include the limited number of patients and low values for the C-index. Conclusion: A new and simple prognostic model was developed for patients with NCMPC, underlying the role of normal or abnormal ALP.
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Submitted on : Friday, September 24, 2021 - 2:51:35 PM
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Gwenaelle Gravis, Jean-Marie Boher, Karim Fizazi, Florence Joly, Franck Priou, et al.. Prognostic Factors for Survival in Noncastrate Metastatic Prostate Cancer: Validation of the Glass Model and Development of a Novel Simplified Prognostic Model. European Urology, Elsevier, 2015, 68 (2), pp.196 - 204. ⟨10.1016/j.eururo.2014.09.022⟩. ⟨inserm-03353959⟩



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