Prognostic Association between Common Laboratory Tests and Overall Survival in Elderly Men with De Novo Metastatic Castration Sensitive Prostate Cancer: A Population-Based Study in Canada

Abstract

De novo cases of metastatic prostate cancer (mCSPC) are associated with poorer prognosis. To assist in clinical decision-making, we aimed to determine the prognostic utility of commonly available laboratory-based markers with overall survival (OS). In a retrospective population-based study, a cohort of 3556 men aged ≥66 years diagnosed with de novo mCSPC between 2014 and 2019 was identified in Ontario (Canada) administrative database. OS was assessed by using the Kaplan–Meier method. Multivariate Cox regression analysis was performed to evaluate the association between laboratory markers and OS adjusting for patient and disease characteristics. Laboratory markers that were assessed include neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), albumin, hemoglobin, serum testosterone and PSA kinetics. Among the 3556 older men with de novo mCSPC, their median age was 77 years (IQR: 71–83). The median survival was 18 months (IQR: 10–31). In multivariate analysis, a statistically significant association with OS was observed with all the markers (NLR, PLR, albumin, hemoglobin, PSA decrease, reaching PSA nadir and a 50% PSA decline), except for testosterone levels. Our findings support the use of markers of systemic inflammation (NLR, PLR and albumin), hemoglobin and PSA metrics as prognostic indicators for OS in de novo mCSPC.

Prognostic impact of serum testosterone in metastatic hormone-naive prostate cancer: a systematic review and meta-analysis

“…After removing duplicates, 785 papers were screened and 40 full-text articles were selected and individually evaluated for eligibility. Finally, 19 studies were included for quantitative and qualitative analysis [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Fig. 1).…”

Trends in the Use of Second-Generation Androgen Receptor Axis Inhibitors for Metastatic Hormone-Sensitive Prostate Cancer and Clinical Factors Predicting Biological Recurrence

“…In contrast, there were no significant differences in OS, rPFS, or biochemical PFS in patients with NLR ≥ 2 from baseline with or without Abi [24]. In a Canadian study of 3556 patients with PCa and newly detected metastases, divided into five groups according to NLR values, patients with a higher NLR had a significantly increased relative risk of PCa death compared to those with a lower NLR (HR, 1.55; 95% CI, 1.27-1.90) [25]. In the study that examined the usefulness of NLR as a predictor of PCa diagnosis and disease progression, the probability of PCa metastasis was significantly increased in patients with high NLR, and the risk of metastasis was reported to be 3.2 times higher in patients with NLR > 2.5 [26].…”

“…Since the tumor microenvironment, particularly the inflammatory response, may play an important role in cancer development and progression, it has been suggested that measuring clinical factors involved in inflammation, such as CRP, albumin, and white blood cells, may predict systemic cancer progression and metastasis [20]. Among them, NLR is widely known to correlate with the prognosis of many urologic cancers, including mHSPC and CRPC [21][22][23][24][25][26]. According to a subgroup analysis of the COU302 trial, which investigated the effect of Abi in patients with mCRPC, oncological outcomes were examined using NLR 2.5 as the cutoff value [24].…”

Presence of CD133‐positive circulating tumor cells predicts worse progression‐free survival in patients with metastatic castration‐sensitive prostate cancer

“…Previous studies have investigated the prognostic factors in CSPC patients. In a retrospective population‐based study of 3556 mCSPC patients conducted in Canada, researchers found that in multivariate analysis, the efficacy of ADT was correlated with neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio, and albumin, hemoglobin, and PSA decrease 17 . Briones et al .…”

“…In a retrospective population-based study of 3556 mCSPC patients conducted in Canada, researchers found that in multivariate analysis, the efficacy of ADT was correlated with neutrophil-to-lymphocyte ratio, platelet-tolymphocyte ratio, and albumin, hemoglobin, and PSA decrease. 17 Briones et al studied the survival of mCSPC patients after receiving docetaxel or abiraterone combination therapy and found that age at diagnosis of mCSPC, PSA90 at 3 months, and LATITUDE risk classification are prognostic factors of PFS. 18 However, these traditional markers all have their own limitations.…”