Monitoring chromogranine A (CgA) serum levels during chemotherapy for hormone refractory prostate cancer (HRPC): Which impact in daily practice?

Abstract

16107 Background: Studies published in the literature on CgA serum levels suggest a possible role in the management of patients with HRPC. Methods: Data from 100 patients treated for HRPC with chemotherapy in our institution from 2002 to 2007 were retrospectively analysed. CgA serum level, clinical and biological parameters [Gleason score, performance status (PS), neuron specific enolase (NSE), prostate-specific antigen (PSA), lactate dehydrogenase (LDH), alkaline phosphatase (PAL), albumin (ALB) and hemoglobin (Hb) serum levels,] and clinical outcomes were collected. Baseline parameters (CgA and others) and their variations during chemotherapy were studied. Cox proportional hazards regression models were used for univariate and multivariate analyses. Results: Median age was 69 at time of chemotherapy. Median follow-up was 13.9 months [range, 1.7 to 53.9]. Gleason score was ≥ 7 in 86% of patients, and 47% of patients had metastases at diagnosis. The median baseline serum levels of CgA, PSA and NSE were respectively 91 ng/ml [normal (N) < 70 ng/ml], 71.5 ng/ml [N<4 ng/ml] and 8 ng/ml [N< 15 ng/ml]. A median of 6 cycles of chemotherapy per patient was delivered. The objective, PSA and neuroendocrine response rates were respectively 41%, 36% and 12%. Median overall survival (OS) was 17 months (95%CI: 13.8–19.7). In univariate analysis, PSA, ALB, CgA and Hb serum levels predicted for overall survival. In multivariate analysis, PSA and ALB confirmed their prognostic role: patients with elevated PSA but a normal ALB level had an OS of 18 months, higher than other patients (10 months). NSE serum level, Gleason score and other parameters had no impact on response or survival. There was no correlation between neuroendocrine, objective or PSA responses. Conclusions: The CgA serum level monitoring during chemotherapy has no interest in routine clinical practice. No significant financial relationships to disclose.