Abstract
Purpose: To investigate the prognostic efficacy of the Geriatric Nutritional Risk Index (GNRI) in patients with metastatic Castration–resistant Prostate Cancer (mCRPC) receiving docetaxel as the first line of treatment. Methods: We retrospectively reviewed patients with mCRPC and receiving first line docetaxel in Taichung Veterans General Hospital from 2006 to 2012. The GNRI was calculated using serum albumin and body mass index, with a poor nutritional status defined as GNRI <92.0. Multivariate Cox-regression analysis was used to evaluate the risk of survival. Results: One-hundred seventy patients with mCRPC were included. One-hundred twenty-five patients were of normal nutritional status (GNRI ≥92) and 45 patients were of poor nutritional status (GNRI <92). The cumulative docetaxel dosage was 600 (360–1,185) mg in the normal nutritional status group and 360 (127.5–660) mg in the poor nutritional status group (p < 0.001). The median overall survival from mCRPC was 30.39 months in the good nutritional status group and 11.07 months in the poor nutritional status group (p of log rank <0.001). In a multivariate model, poor nutritional status was an independent risk factor in overall survival (Hazard Ratio [HR] = 5.37, 95% Confidence Interval [CI] 3.27–8.83), together with a high metastatic volume (HR = 4.03, 95% CI 2.16–7.53) and docetaxel cumulative dosage (HR = 0.999, 95% CI 0.999–0.9998). Conclusion: Poor nutritional status with a GNRI <92 is associated with shorter progression free survival and overall survival in mCRPC patients treated with docetaxel. Metastatic volume and cumulative docetaxel dosage are also independent prognostic factors in overall survival.
Highlights
Prostate cancer accounts for the most common type of cancer in men, while having the second highest cancer related death rate (Siegel et al, 2018)
Clinical characteristics including pretreatment Prostatespecific Antigen (PSA), Alkaline phosphatase (ALP), Lactate dehydrogenase (LDH), performance status, hemoglobin, Gleason sum, visceral or liver metastases, PSA doubling time, clinical significance of pain and number of metastases have all been recognized as the prognostic predictive factors for Overall Survival (OS) in metastatic Castration-resistant Prostate Cancer (mCRPC) patients treated with docetaxel (Halabi et al, 2003; Armstrong et al, 2007; Armstrong et al, 2010)
One-hundred twenty-five patients categorized as normal nutrition (GNRI ≥92.0) and 45 patients grouped as poor nutrition (GNRI
Summary
Prostate cancer accounts for the most common type of cancer in men, while having the second highest cancer related death rate (Siegel et al, 2018). Due to the rise in prostate cancer and its progress depending upon the androgen signal pathway, androgen deprivation therapy with medical or surgical castration has been used as an effective therapeutic strategy since 1942 (Huggins, 1942). Disease progression occurs despite under castration level as the condition of metastatic Castration-resistant Prostate Cancer (mCRPC) remains the leading cause of death in prostate cancer patients (Hussain et al, 2009). Three weekly doses of Docetaxel 75 mg/m2, along with androgen deprivation therapy improved mCRPC, with a median 18.9 months overall survival period, a 45 percent PSA response rate and a 35 percent improved symptom rate (Tannock et al, 2004). Clinical characteristics including pretreatment PSA, Alkaline phosphatase (ALP), Lactate dehydrogenase (LDH), performance status, hemoglobin, Gleason sum, visceral or liver metastases, PSA doubling time, clinical significance of pain and number of metastases have all been recognized as the prognostic predictive factors for Overall Survival (OS) in mCRPC patients treated with docetaxel (Halabi et al, 2003; Armstrong et al, 2007; Armstrong et al, 2010)
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