Abstract
BackgroundCastration-resistant prostate cancer (CRPC) patients have poor prognoses, and docetaxel (DTX) is among the few treatment options. An accurate risk classification to identify CRPC patient groups for which DTX would be effective is urgently warranted. The Armstrong risk classification (ARC), which classifies CRPC patients into 3 groups, is superior; however, its usefulness remains unclear, and further external validation is required before clinical use. This study aimed to examine the clinical significance of the ARC through external validation in DTX-treated Japanese CRPC patients.MethodsCRPC patients who received 2 or more DTX cycles were selected for this study. Patients were classified into good-, intermediate-, and poor-risk groups according to the ARC. Prostate-specific antigen (PSA) responses and overall survival (OS) were calculated and compared between the risk groups. A multivariate analysis was performed to clarify the relationship between the ARC and major patient characteristics.ResultsSeventy-eight CRPC patients met the inclusion criteria. Median PSA levels at DTX initiation was 20 ng/mL. Good-, intermediate-, and poor-risk groups comprised 51 (65%), 17 (22%), and 10 (13%) patients, respectively. PSA response rates ≥30% and ≥50% were 33%, 41%, and 30%, and 18%, 41%, and 20% in the good-, intermediate-, and poor-risk groups, respectivcixely, with no significant differences (p = 0.133 and 0.797, respectively). The median OS in the good-, intermediate-, and poor-risk groups were statistically significant (p < 0.001) at 30.1, 14.2, and 5.7 months, respectively. A multivariate analysis revealed that the ARC and PSA doubling time were independent prognostic factors.ConclusionsMost of CRPC patients were classified into good-risk group according to the ARC and the ARC could predict prognosis in DTX-treated CRPC patients.Trial registrationUniversity Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) number, UMIN000011969.
Highlights
Castration-resistant prostate cancer (CRPC) patients have poor prognoses, and docetaxel (DTX) is among the few treatment options
The Armstrong risk classification (ARC), which classifies CRPC patients into 3 groups according to 4 risk factors, including visceral metastases, bone scan progression, significant pain, and anemia, is a superior risk classification because it can be used in clinical practice without reducing the predictive abilities of nomograms and can predict survival and post-chemotherapy prostatespecific antigen (PSA) declines and tumor responses [10]
The objective of this study was to examine the clinical significance of ARC through external validation in DTXtreated Japanese CRPC patients
Summary
Castration-resistant prostate cancer (CRPC) patients have poor prognoses, and docetaxel (DTX) is among the few treatment options. An accurate risk classification to identify CRPC patient groups for which DTX would be effective is urgently warranted. The Armstrong risk classification (ARC), which classifies CRPC patients into 3 groups, is superior; its usefulness remains unclear, and further external validation is required before clinical use. This study aimed to examine the clinical significance of the ARC through external validation in DTX-treated Japanese CRPC patients. Castration-resistant prostate cancer (CRPC) patients have poor prognoses. Predictions and classifications of CRPC patients’ clinical outcomes and prognoses for the effective use of the limited treatment options offer prolonged in clinical practice. ARC was demonstrated to significantly classify the clinical outcomes of estramustine phosphate (EMP) treatment in CRPC patients [11]
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