ABSTRACT
The pretreatment serum albumin/globulin ratio (AGR) has been used as a prognostic biomarker for various cancer types. However, the prognostic value of the AGR for prostate cancer, especially for metastatic prostate cancer (mPCa) after maximal androgen blockade (MAB), remains unclear. The aim of this study was to evaluate the prognostic value of the pretreatment serum AGR for mPCa treated with MAB. This retrospective study included 214 mPCa patients receiving MAB from October 2007 to March 2017. The correlation of the AGR with survival was estimated using Kaplan-Meier analysis and Cox proportional hazards models. The cutoff value of the AGR was 1.45 according to the receiver operating characteristic curve. Kaplan-Meier analysis demonstrated that patients with a low AGR (<1.45) had poor outcomes in terms of progression-free survival (PFS) and cancer-specific survival (CSS). Multivariate Cox analyses showed that the AGR was an independent predictor of PFS (hazard ratio [HR] = 0.642; 95% confidence interval [CI]: 0.430-0.957; P = 0.030) and CSS (HR = 0.412; 95% CI: 0.259-0.654; P < 0.001). Furthermore, in a subset of 79 patients with normal serum albumin levels (≥40.0 g l-1), the serum AGR remained an independent predictor of CSS (P = 0.009). The pretreatment AGR was an independent prognostic biomarker for PFS and CSS in patients with mPCa receiving MAB. In addition, the AGR remained effective for the prediction of CSS in patients with normal albumin levels (≥40 g l-1). However, further prospective studies are needed to confirm our conclusions.
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Objective To investigate the efficacy of pretreatment systemic inflammation response index (SIRI) in predicting the prognostic of prostate cancer (PCa) patients treated with maximal androgen blockade (MAB).Methods The data of 351 PCa patients who had undergone MAB as first-line therapy between January 2010 and June 2015,were retrospectively analyzed.The age of patients in our cohort ranged from 51 to 89 years old,mean 76 years old.The median value of PSA was 91.60ng/ml,ranging 0.11-1 000.00 ng/ml.39 cases had a Gleason score of 6,47 cases had a score of 3 + 4,89 cases had a score of 4 +3,107 cases had a score of 8,and 69 cases had a score of 9-10.158 cases had bone metastasis.Patients were categorized in two groups using a cut-off point of 1.2 as calculated by the receiver-operating curve analysis.Correlations between SIRI and clinical characteristics were analyzed.Meanwhile,univariate and multivariate cox regression analyses were performed to determine the associations of SIRI with progression-free survival (PFS),cancer-specific survival (CSS) and overall survival (OS).Results The median follow-up duration was 43.0 months,ranging 9-75 months.The disease progression occurred in 162 patients,91 patients died,including 75 who died because of PCa at the end of the last follow-up.The differences of age,Gleason score and incidence of metastasis between low SIRI group (＜ 1.2) and high SIRI group (≥1.2) were not significant (P ＞0.05).But the patients in high SIRI group had higher PSA (P =0.046).Multivariate analyses identified SIRI,Gleason score and metastasis as independent prognostic factors for PFS,CSS and OS.Conclusions Pretreatment SIRI ≥ 1.2 was an independent predictor for poor prognosis in PCa patients treated with MAB.
ABSTRACT
The pretreatment serum albumin/globulin ratio (AGR) has been used as a prognostic biomarker for various cancer types. However, the prognostic value of the AGR for prostate cancer, especially for metastatic prostate cancer (mPCa) after maximal androgen blockade (MAB), remains unclear. The aim of this study was to evaluate the prognostic value of the pretreatment serum AGR for mPCa treated with MAB. This retrospective study included 214 mPCa patients receiving MAB from October 2007 to March 2017. The correlation of the AGR with survival was estimated using Kaplan-Meier analysis and Cox proportional hazards models. The cutoff value of the AGR was 1.45 according to the receiver operating characteristic curve. Kaplan-Meier analysis demonstrated that patients with a low AGR (<1.45) had poor outcomes in terms of progression-free survival (PFS) and cancer-specific survival (CSS). Multivariate Cox analyses showed that the AGR was an independent predictor of PFS (hazard ratio [HR] = 0.642; 95% confidence interval [CI]: 0.430-0.957; P = 0.030) and CSS (HR = 0.412; 95% CI: 0.259-0.654; P < 0.001). Furthermore, in a subset of 79 patients with normal serum albumin levels (≥40.0 g l-1), the serum AGR remained an independent predictor of CSS (P = 0.009). The pretreatment AGR was an independent prognostic biomarker for PFS and CSS in patients with mPCa receiving MAB. In addition, the AGR remained effective for the prediction of CSS in patients with normal albumin levels (≥40 g l-1). However, further prospective studies are needed to confirm our conclusions.
ABSTRACT
Objective To evaluate the prognostic value of pretreatment neutrophil to lymphocyte ratio (NLR) on prostate cancer patients treated with maximal androgen blockade (MAB).Methods The clinical data of 249 prostate cancer patients treated with MAB in our hospital from October 2007 to March 2017 were retrospectively analyzed.Among all the patients,the median age was 72 years old (ranged 48 to 89 years).The BMI was 14.5-31.8kg/m2 (median 23.0 kg/m2).The PSA was 1.00-758.21 ng/ml (median 60.04 ng/ml).216 patients' tumor invaded surrounding tissues;lymph node metastasis occurred in 157 patients;and distant organ metastasis occurred in the remaining 174 patients.The Gleason score was 3-10 (median 7).Copfimary end points were progression-free survival (PFS) and cancer-specific survival (CSS).The best cutoff value of NLR was calculated by receiver operating characteristic (ROC) curve.The prognostic analysis of NLR on prostate cancer patients treated with MAB was estimated using Cox proportional hazards models and Kaplan-Meier analysis.Results The ideal cutoff value of the pretreatment NLR was 2.29 (95％ CI 0.603-0.737,P ＜0.001) determined by the ROC curve according to the survived and deceased cases at the end point of CSS,by which the 249 patients was divided into the high NLR group of 119 patients (47.8％) and the low NLR group of 130 patients (52.2％).High NLR was significantly associated with high Gleason score (P =0.019),higher clinical T stage (P =0.001),N stage (P ＜ 0.001),M stage (P ＜ 0.001) and more neutrophil count (P ＜ 0.001).The median follow-up time was 29 months (ranged 5 to 124).During this period,115 patients died,and the whole fatality rate was 46.2％.40 patients died in low NLR group (30.8％),while the figures for the high NLR group were 75 (63.0％).Kaplan-Meier analysis demonstrated that patients with NLR ≥ 2.29 had a poor outcome both in PFS (P ＜ 0.001) and CSS (P ＜ 0.001).The multivariate Cox analysis showed that NLR,Gleason score,clinical TNM stage and ECOG score were independent predictors for PFS and CSS.Conclusion Pretreatment NLR could be an independent prognostic biomarker for PFS and CSS in prostate cancer patients undergoing MAB.
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Objective To investigate the cognitive function of patients with prostate cancer after maximal androgen blockade therapy and its influenced factors,and to provide a new way for early prevention strategy.Methods Montreal cognitive assessment (MoCA),hospital anxiety depression scale (HAD),social support rating scale (SSRS) and self-designed questionnaire were used in 56 cases treated with maximum androgen blockade therapy for more than six months and 37 cases who underwent radical prostatectomy treatment to evaluate their cognitive function and collect the observation indexes between January 2013 and October 2015.Based on MoCA score,all patients were divided into cognitive dysfunction group (n =40) and normal cognitive function group (n =53).The observation indexes in two groups were compared and cognitive function with different treatment in two groups were analyzed.The changes on the influencing factors of cognitive function in patients were filtered using multivariable logistic regression analysis.Results In the cognitive dysfunction group and normal group,the proportion of MAB treatment was 80.0％ (32/40) vs.45.3％ (24/53),the age was 73.7 vs.73.7 years,the proportion of solitary was 32.5％ (13/40) vs.13.2％ (7/53),the proportion of depressive symptoms was 87.5％ (35/40) vs.62.3％ (33/53),the social support level was 32.5 vs.41.1 and the proportion of testosterone decreased was 95.0％ (38/40) vs.45.3％ (24/53).All events showed statistically significant differences (P ＜0.05).Compared MAB treatment group with radical surgical treatment group,the testosterone level was (0.27-±O.15) vs.(12.14 ± 1.86) nmol/L,visual space and executive function score was 4.18 ±0.79 vs.4.54 ±0.56,attention score was 4.73 ±0.99 vs.5.16 ±0.79,delayed memory score was 3.75 ± 1.21 vs.4.30 ± 1.05 and MoCA score was 26.13 ± 1.48 vs.27.27 ± 1.39,which all showed the statistically significant difference (P ＜ 0.05).The results of multiple regression analysis showed that age (OR =1.183,95％ CI 1.135-1.223),depressive symptoms (OR =1.092,95％ CI 1.047-1.149),social support (OR =0.897,95％ CI O.838-0.956),testosterone (OR =2.105,95％ CI 1.369-4.083) were the influenced factors of cognitive dysfunction.Conclusions The incidence of cognitive dysfunction in patients with prostate cancer after maximal androgen blockade therapy more than six months was higher than others.Age,depression,social support level and testosterone levels were related to the occurrence of cognitive dysfunction.
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Objective To study the value of PSADT in predicting the prognosis and the possibility of disease progression for patients with prostate cancer after MAB therapy.Methods Based on the retrospective review of the history and the follow-up of 159 prostate cancer patients,who received MAB therapy in our department from January 1994 to December 2010,PSADT values were calculated and survival analysis was performed.The ages at diagnosis ranged from 54 to 90 years with a median of 74 years.The pretreatment PSA value ranged from 2.6 to 275.0 μg/L with a median of 46.8 μg/L.The patients of Gleason score ≤6,7 and ≥8 constituted 27.7％,42.1％ and 25.2％,respectively.Only 26.4％ of the patients were staged as T1N0M0-T2N0M0 and the others had locally advanced disease or metastasis.A multivariate analysis with a Cox's proportional hazard model was used and the disease progression rates in different PSADT groups were also compared.Chi-square test and Log-rank test were applied in statistic analysis.Results The 159 patients received follow-up with a median period of 28 months (6-126 m).The median PSADT of these 159 patients was 5.7 months (0.5-21.0 m).The 3-year and 5-year survival for the 71 patients,whose PSADT were not less than 6 months,were 89.4％ and 47.6％ respectively,compared with 49.8％ and 30.6％ for the other 88 patients whose PSADT were less than 6 months.The survivals were significantly different between the two groups (P ＜ 0.01).It was confirmed by a further multivariate analysis with a Cox' s proportional hazard model that PSADT was one of the predictive factors of the prognosis of these prostate cancer patients with a hazard ratio of 2.6 (P ＜ 0.01).Moreover,disease progression were found in 19.7％ of the PSADT≥6 m group during the follow-up compared with 63.6％ in the PSADT ＜6 m group.The disease progression rates were also significantly different (P ＜ 0.0 l).Conclusions PSADT can be used to predict the prognosis of patients with prostate cancer after the MAB therapy.The survival for the patients,whose PSADT are not less than 6 months,is higher than those whose PSADT less than 6 months.Meanwhile,PSADT can predict the possibility of disease progression after MAB treatment.