A multivariate prognostic nomogram incorporating PSA kinetics in hormone-refractory metastatic prostate cancer (HRPC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5058-5058
Author(s):  
M. Eisenberger ◽  
E. S. Garrett-Mayer ◽  
Y. Ou Yang ◽  
R. de Wit ◽  
I. Tannock ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prognostic Factors ◽  
Median Survival ◽  
Cox Model ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Tumor Grade ◽  
Multivariate Model ◽  
Psa Kinetics ◽  
Hormone Refractory

5058 Background: To develop a prognostic model and nomogram using baseline clinical variables to predict death among men with metastatic hormone-refractory prostate cancer (HRPC). Methods: TAX 327 was a clinical trial that randomized 1,006 men with metastatic HRPC to receive 3-weekly or weekly docetaxel or mitoxantrone, each with prednisone. Of these, 635 men had baseline data that included PSA kinetics, with 518 mortality events recorded as of November 2006. We developed a multivariate Cox model and nomogram to predict survival at two, three, and five years. Results: Ten independent prognostic factors were identified in multivariate analysis and include: 1) presence of liver metastases (HR 1.64, p=0.02), 2) number of metastatic sites (HR 1.58 if =2 sites, p=0.001), 3) clinically significant pain at baseline (HR 1.46, p<0.0001), 4) Karnofsky Performance Status (HR 1.42 if =70, p=0.01), 5) type of progression at baseline (HR 1.40 for measurable disease progression and 1.28 for bone scan progression, p=0.002 and 0.014 respectively), 6) pretreatment PSA doubling time (PSADT, HR 1.20 if <55 days, p=0.048), 7) baseline PSA (HR 1.17 per log rise, p<0.0001), 8) tumor grade (HR 1.18 for high grade, p=0.076), 9) alkaline phosphatase (HR 1.26 per log rise, p<0.0001), and 10) hemoglobin (HR 1.10 per unit decline, p=0.006). A PSADT <55 days (median value for this dataset) was associated with other adverse prognostic factors, but was independently associated with shortened overall survival. Men with a PSA less than the median of 114 ng/ml and longer PSADT (=55 days) had a median survival of 24.7 months, while those with higher PSA and shorter PSADT had a median survival of 13.8 months. A nomogram was developed based on this Cox multivariate model and validated internally using bootstrap methods, with a concordance index of 0.69. Conclusions: This multivariate model identified several prognostic factors in men with metastatic HRPC including PSADT, and led to the successful development of a clinically applicable nomogram. External prospective validation may support the wider use of this prognostic baseline model for men with HRPC treated with chemotherapy. No significant financial relationships to disclose.

Timing of PSA response to guide cessation of docetaxel in prostate cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16069-e16069
Author(s):  
Peter D. Dickinson ◽  
Jahangeer Malik ◽  
Finbar Slevin ◽  
Ananth Sivanandan ◽  
Noel W. Clarke ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Median Survival ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Prognostic Significance ◽  
Single Centre ◽  
Prognostic Group ◽  
Psa Response ◽  
Number Of Cycles ◽  
Docetaxel Chemotherapy

e16069 Background: Docetaxel plus prednisolone is an established treatment for men with advanced prostate cancer. Clinicians need to be able to identify men who are not benefiting from chemotherapy, and a key unanswered question is how many cycles of docetaxel should men receive before this assessment is made. We investigated the prognostic significance of a PSA response to docetaxel chemotherapy and the number of cycles after which an absence of PSA response could reliably predict future non-response. Methods: Data was collected for men who received one to ten cycles of docetaxel for castrate refractory prostate cancer between 2005 and 2011. PSA was monitored during treatment. All men were treated at a single centre, The Christie NHS Foundation Trust, UK. Survival is defined as the interval between the first dose of docetaxel and the date of death. Results: Data was available for 320 patients. At the commencement of chemotherapy, median age was 67 years (range 49-81yrs) and median PSA was 207ng/ml. All patients had a Karnofsky Performance Status ≥ 70%. There were 239 deaths and the median survival of the whole group was 403 days. 140 (44%) patients received 6 cycles of docetaxel and 23 patients (7%) received 10 cycles. Median survival was significantly longer in men who had any fall in PSA during chemotherapy compared to those whose PSA did not fall (462 days vs 268 days, p<0.001). Any PSA fall occurred during the first 4 cycles of docetaxel for 95.1% of men. Median survival was significantly longer in men who had a 50% fall in PSA during chemotherapy compared to those who did not (491 vs 357 days, p<0.001). The 50% fall in PSA occurred during the first 5/6 cycles of chemotherapy in 91.5% and 97.7% of men respectively. Conclusions: A patient’s clinical condition is of paramount importance when assessing them during docetaxel chemotherapy. Our data suggest that a fall in PSA following docetaxel is an indicator of improved overall survival. PSA response could help clinicians decide when to stop docetaxel; patients are unlikely to have a fall in PSA if it has not occurred during the first 4 cycles of chemotherapy and they fall into a poor prognostic group. These patients should be considered for alternative treatment in order to improve outcomes and spare them unnecessary toxicity.

Usefulness of medical oncologists’ estimates of survival time in people with advanced cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9087-9087
Author(s):  
Belinda E. Kiely ◽  
Andrew J. Martin ◽  
Martin HN Tattersall ◽  
Anna K. Nowak ◽  
David Goldstein ◽  
...  
Keyword(s):  
Survival Time ◽  
Advanced Cancer ◽  
Median Survival ◽  
Cox Model ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Prognostic Significance ◽  
Case Scenario ◽  
Worst Case ◽  
Medical Oncologists

9087 Background: We sought to determine the calibration, precision, prognostic significance and suitability of estimated survival time (EST) as a basis for estimating and explaining prognosis in advanced cancer. Methods: Medical oncologists recorded their EST as the “median survival of a group of identical patients” in patients with advanced cancer and a life expectancy >3 months recruited to a randomized trial of sertraline (Lancet Oncol 2007; 8: 603). Calibration, precision and suitability were defined by the proportions of patients whose observed survival times (OST) were bounded by simple multiples of their EST (based on our previous studies), i.e. 50% expected to live longer (or shorter) than their EST; 30% expected to live from 0.75 to 1.33 times their EST (arbitrary criterion for precision); 50% expected to live from half to double their EST (range for typical scenario); 10% expected to live >3 times their EST (best case scenario), or <¼ of their EST (worst case scenario). Results: Characteristics of the 114 patients were: median age 63 years, Karnofsky performance status (KPS) ≤70 in 25%, and a median of 8.5 months since diagnosis of advanced cancer. Primary cancer sites included breast (18%), colorectal (16%), lung (15%), prostate (12%) and ovary (10%). Median survival was 10.6 months after a median follow-up of 14 months and 68 deaths. EST were well-calibrated: 54% of patients lived longer than their EST and 46% lived shorter than their EST. EST were imprecise (21% within 0.75 to 1.33 times OST) but equally likely to be over-optimistic (34% >1.33 x OST) or over-pessimistic (39% <0.75 x OST). 6% of patients lived <¼ of their EST; 62% lived from half to double their EST and 9% lived >3 times their EST. Independently significant predictors of OST in a multivariable Cox model included EST (HR=0.92, p=0.004), dry mouth (HR=5.07, p<0.0001), alkaline phosphatase >101U/L (HR=2.80, p=0.0002), KPS ≤70 (HR=2.30, p=0.007), prostate primary (HR=0.23, p=0.002), and steroid use (HR=2.35, p=0.02). Conclusions: Medicaloncologists’ EST were well-calibrated, imprecise, independently associated with OST, and useful for estimating and explaining best case, worse case, and typical scenarios for survival time in patients with advanced cancer.

Phase II evaluation of oral estramustine and oral etoposide in hormone-refractory adenocarcinoma of the prostate.

1994 ◽  
Vol 12 (10) ◽  
pp. 2005-2012 ◽  
Author(s):  
K J Pienta ◽  
B Redman ◽  
M Hussain ◽  
G Cummings ◽  
P S Esper ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Soft Tissue ◽  
Median Survival ◽  
Performance Status ◽  
Specific Antigen ◽  
Complete Response ◽  
Experimental Models ◽  
Survival Duration ◽  
Median Survival Duration ◽  
Hormone Refractory

PURPOSE Estramustine and etoposide (VP-16) have been demonstrated to inhibit the growth of prostate cancer cells in experimental models. This led us to evaluate the effectiveness of this combination in the treatment of patients with metastatic prostate carcinoma refractory to hormone therapy. PATIENTS AND METHODS Estramustine 15 mg/kg/d and VP-16 50 mg/m2/d, were administered orally in divided doses for 21 days. Patients were then taken off therapy for 7 days and the cycle then repeated. Therapy continued until evidence of disease progression. RESULTS Forty-two patients have been enrolled onto this trial with a minimum of 40 weeks follow-up. Of 18 patients with measurable soft tissue disease, three demonstrated a complete response (CR) and six a partial response (PR) for longer than 2 months. Of these 18 patients, pretreatment prostate-specific antigen (PSA) levels decreased by at least 75% in five men (28%) and by at least 50% in nine (50%). The median survival duration has not been reached in those patients who demonstrated a response either by soft tissue or PSA criteria. Of 24 patients with disease limited to bone, six (25%) demonstrated improvement and nine (38%) demonstrated stability in their bone scans. Five men (21%) demonstrated a decrease of at least 75% in pretreatment PSA levels and 14 (58%) demonstrated at least a 50% decrease; the median survival duration has not been reached in these patients. Pretreatment performance status is an important predictor of survival. CONCLUSION We conclude that the combination of estramustine and VP-16 is an active oral regimen in hormone-refractory prostate cancer.

Prognostic Factors and Outcome of Human Herpesvirus 8–Associated Primary Effusion Lymphoma in Patients With AIDS

2005 ◽  
Vol 23 (19) ◽  
pp. 4372-4380 ◽  
Author(s):  
Emmanuelle Boulanger ◽  
Laurence Gérard ◽  
Jean Gabarre ◽  
Jean-Michel Molina ◽  
Christophe Rapp ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Survival Rate ◽  
Median Survival ◽  
Primary Effusion Lymphoma ◽  
Performance Status ◽  
Human Herpesvirus ◽  
Disease Free Survival ◽  
Hazard Ratio ◽  
Human Herpesvirus 8 ◽  
Herpesvirus 8

PurposePrimary effusion lymphoma (PEL) is a rare high-grade B-cell non-Hodgkin's lymphoma associated with Kaposi sarcoma–associated herpesvirus/human herpesvirus 8 (KSHV/HHV-8) infection, and is mostly observed in the course of HIV infection. The prognosis is poor, with reported median survival time shorter than 6 months. To date, no prognostic factor has been identified in this subset of lymphoma.Patients and MethodsWe describe here a large series of HIV-infected patients with PEL, including 28 cases diagnosed in six centers during an 11-year time period. Prognosis analysis was performed using a Cox proportional hazard regression model. Statistically significant covariates were further analyzed in a forward, stepwise multivariate model.ResultsAfter a median follow-up of 3.8 years (range, 10 months to 10.8 years), nine patients (32%) were still alive, and eight of them remained progression free. The median survival was 6.2 months, and the 1-year overall survival rate was 39.3%. Fourteen patients (50%) achieved complete remission, with a 1-year disease-free survival rate at 78.6%. In a multivariate analysis, only a performance status more than 2 (hazard ratio, 5.84; 95% CI, 1.76 to 19.33) and the absence of highly active antiretroviral therapy (HAART) before PEL diagnosis (hazard ratio, 3.26; 95% CI, 1.14 to 9.34) were found to be independent predictors for shorter survival.ConclusionBased on a retrospective series of 28 patients, two prognostic factors were identified as being independently associated with impaired clinical outcome in HIV-related PEL—(1) a poor performance status and (2) the absence of HAART before PEL diagnosis.

Interferon alfa-2a in advanced renal cell carcinoma: treatment results and survival in 159 patients with long-term follow-up.

1993 ◽  
Vol 11 (7) ◽  
pp. 1368-1375 ◽  
Author(s):  
L M Minasian ◽  
R J Motzer ◽  
L Gluck ◽  
M Mazumdar ◽  
V Vlamis ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Prognostic Factors ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Interferon Alfa ◽  
Advanced Renal Cell Carcinoma ◽  
Survival Duration

PURPOSE Three trials were conducted to define the efficacy and toxicity of interferon alfa-2a in the treatment of metastatic renal cell cancer. Univariate and multivariate analyses were performed to identify prognostic factors for survival. PATIENTS AND METHODS Prospectively, 159 patients were treated with interferon alfa-2a. In the first trial, 42 patients received 50 x 10(6) U/m2 intramuscularly three times per week. In the second trial, 64 patients received gradually escalating doses of interferon alfa-2a from 3 to 36 x 10(6) U subcutaneously administered daily. The third trial was randomized; 25 patients received daily interferon alfa-2a alone and 28 were treated with daily interferon alfa-2a and 0.15 mg/kg vinblastine every 3 weeks. RESULTS The overall response proportion was 10% (two complete and 14 partial responses). The median response duration was 12.2 months. The median survival duration was 11.4 months, with 3% of patients alive at 5 or more years. A univariate statistical analysis showed that a Karnofsky performance status > or = 80, prior nephrectomy, and interval from diagnosis to treatment of longer than 365 days were significant prognostic factors for survival. In a multivariate analysis, only prior nephrectomy and Karnofsky performance status > or = 80 were shown to be independent predictors of survival. CONCLUSION Interferon alfa-2a had minimal antitumor activity in patients with advanced renal cell carcinoma and long-term survival was achieved in a small proportion of patients. The need for continued investigation and the identification of more effective therapy for advanced renal cell carcinoma is evident from the poor overall survival rate observed in these 159 patients. The investigation of new agents and of interferon alfa-2a in combination with other agents remains a priority.

PSA Kinetics Provide Improved Prediction of Survival in Metastatic Hormone-Refractory Prostate Cancer

Urology ◽  
2008 ◽  
Vol 72 (4) ◽  
pp. 903-907 ◽  
Author(s):  
David Robinson ◽  
Gabriel Sandblom ◽  
Robert Johansson ◽  
Hans Garmo ◽  
Gunnar Aus ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Hormone Refractory Prostate Cancer ◽  
Psa Kinetics ◽  
Prediction Of Survival ◽  
Hormone Refractory

scholarly journals Prognostic factors in glioblastoma multiforme

2010 ◽  
Vol 29 (04) ◽  
pp. 121-125 ◽  
Author(s):  
Leonardo Welling ◽  
José Carlos Lynch ◽  
Celestino Pereira ◽  
Ricardo Andrade ◽  
Fabiana Polycarpo Hidalgo ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Glioblastoma Multiforme ◽  
Retrospective Analysis ◽  
Tumor Volume ◽  
Standard Treatment ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Surgical Techniques ◽  
The Other ◽  
Tumor Removal

Abstract Objective: To study if the prognosis variables such as age, the Karnofsky Performance Status (KPS), extension of tumor removal by surgery, radiotherapy and tumor volume influenced the survival of patients with glioblastoma multiforme (GBM). Method: Retrospective analysis of GBM patients operated at Hospital dos Servidores do Estado between 1998 and 2008. Results: We could observe that age, the KPS and radiotherapy influenced the survival. The other variables did not have any prognosis implications. Conclusions: Despite many researches and many improvements regarding the diagnosis and the surgical techniques, the survival of patients with GBM has not changed in the last 30 years and is a therapeutic challenge. The surgical resection followed by radiotherapy is the standard treatment for patients with GBM. The importance of each variable in the patient's prognosis is still to be established in the multivariate analyzes.

Evaluation of Prognostic Factors for Early Mortality After Stereotactic Radiosurgery for Brain Metastases: a Single Institutional Retrospective Review

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 128-136 ◽  
Author(s):  
E Emily Bennett ◽  
Michael A Vogelbaum ◽  
Gene H Barnett ◽  
Lilyana Angelov ◽  
Samuel Chao ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Karnofsky Performance Status ◽  
Systemic Disease ◽  
Performance Status ◽  
Early Death ◽  
Tumor Type ◽  
Prognostic Groups ◽  
Prior Surgery

Abstract BACKGROUND Stereotactic radiosurgery (SRS) is used commonly for patients with brain metastases (BM) to improve intracranial disease control. However, survival of these patients is often dictated by their systemic disease course. The value of SRS becomes less clear in patients with anticipated short survival. OBJECTIVE To evaluate prognostic factors, which may predict early death (within 90 d) after SRS. METHODS A total of 1427 patients with BM were treated with SRS at our institution (2000-2012). There were 1385 cases included in this study; 1057 patients underwent upfront SRS and 328 underwent salvage SRS. The primary endpoint of the study was all-cause mortality within 90 d after first SRS. Multivariate analyses were performed to develop prognostic indices. RESULTS Two hundred sixty-six patients (19%, 95% confidence interval 17%-21%) died within 90 d after SRS. Multivariate analysis of upfront SRS patients showed that Karnofsky Performance Status, primary tumor type, extracranial metastases, age at SRS, boost treatment, total tumor volume, prior surgery, and interval from primary to BM were independent prognostic factors for 90-d mortality. The first 4 factors were also independent predictors in patients treated with salvage SRS. Based on these factors, an index was defined for each group that categorized patients into 3 and 2 prognostic groups, respectively. Ninety-day mortality was 5% to 7% in the most favorable cohort and 36% to 39% in the least favorable. CONCLUSION Indices based on readily available patient, clinical, and treatment factors that are highly predictive of early death in patients treated with upfront or salvage SRS can be calculated and used to define well-separated prognostic groups.

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