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.

Christopher J D Wallis,Katherine F Y Chan,Robert J Hamilton,Ricardo Fernandes,Soumyajit Roy,Naveen S Basappa,Tamim Niazi,Sebastien J Hotte,Huong Hew,Ilias Cagiannos,Fred Saad,Bobby Shayegan,Krista L Noonan,Laura Park-Wyllie,Cristiano Ferrario,Shawn Malone,Scott C Morgan,Geoffrey T Gotto

doi:10.3390/cancers13112844

Abstract

Simple SummaryDespite significant advancements in the treatment of metastatic prostate cancer, a validated prognostic tool for patients with de novo metastatic castration-sensitive prostate cancer (mCSPC) is still lacking. Using population-based data from Ontario, Canada, we examined the prognostic association between common laboratory tests and survival for patients with mCSPC. These low-cost commonly available laboratory tests, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, albumin, hemoglobin, PSA decrease and PSA nadir, were significantly associated with OS. They can provide important prognostic information and should be utilized more frequently among patients with newly diagnosed mCSPC.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.

Highlights

Prostate cancer (PCa) is the most common solid organ tumor in Canadian men [1,2,3].Nearly a quarter of all PCa patients will have metastatic disease at some point in their disease trajectory, with a third of having metastatic disease at diagnosis [1,4]which are associated with worse prognosis [5,6]
We evaluated the association of several exposure variables of interest with overall survival (OS): markers of systemic inflammation (baseline neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and albumin), baseline hemoglobin, baseline testosterone levels and prostate-specific antigen (PSA) metrics (50% PSA decrease, PSA percentage change from baseline, PSA nadir
From 2014 to 2019, we identified 3556 patients of age 66 years or older who presented with de novo metastatic PCa

Summary

Introduction

Prostate cancer (PCa) is the most common solid organ tumor in Canadian men [1,2,3].Nearly a quarter of all PCa patients will have metastatic disease at some point in their disease trajectory, with a third of having metastatic disease at diagnosis (de novo) [1,4]which are associated with worse prognosis [5,6]. Prostate cancer (PCa) is the most common solid organ tumor in Canadian men [1,2,3]. In the hormone-naïve setting, the median overall survival (OS) among patients with metastatic prostate cancer receiving conventional treatment (i.e., androgen-deprivation therapy (ADT)) is 36–40 months [4,5,7] and is reportedly much worse (

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