title: Prognostic Factors for Survival in Noncastrate Metastatic Prostate Cancer: Validation of the Glass Model and Development of a Novel Simplified Prognostic Model.
abstract: BACKGROUND
  The Glass model developed in 2003 uses prognostic factors for noncastrate metastatic prostate cancer (NCMPC) to define subgroups with good, intermediate, and poor prognosis.
  
  
  OBJECTIVE
  To validate NCMPC risk groups in a more recently diagnosed population and to develop a more sensitive prognostic model.
  
  
  METHODS
  NCMPC patients were randomized to receive continuous androgen deprivation therapy (ADT) with or without docetaxel in the GETUG-15 phase 3 trial. Potential prognostic factors were recorded: age, performance status, Gleason score, hemoglobin (Hb), prostate-specific antigen, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), metastatic localization, body mass index, and pain.
  
  
  METHODS
  These factors were used to develop a new prognostic model using a recursive partitioning method. Before analysis, the data were split into learning and validation sets. The outcome was overall survival (OS).
  
  
  CONCLUSIONS
  For the 385 patients included, those with good (49%), intermediate (29%), and poor (22%) prognosis had median OS of 69.0, 46.5 and 36.6 mo (p=0.001), and 5-yr survival estimates of 60.7%, 39.4%, and 32.1%, respectively (p=0.001). The most discriminatory variables in univariate analysis were ALP, pain intensity, Hb, LDH, and bone metastases. ALP was the strongest prognostic factor in discriminating patients with good or poor prognosis. In the learning set, median OS in patients with normal and abnormal ALP was 69.1 and 33.6 mo, and 5-yr survival estimates were 62.1% and 23.2%, respectively. The hazard ratio for ALP was 3.11 and 3.13 in the learning and validation sets, respectively. The discriminatory ability of ALP (concordance [C] index 0.64, 95% confidence interval [CI] 0.58-0.71) was superior to that of the Glass risk model (C-index 0.59, 95% CI 0.52-0.66). The study limitations include the limited number of patients and low values for the C-index.
  
  
  CONCLUSIONS
  A new and simple prognostic model was developed for patients with NCMPC, underlying the role of normal or abnormal ALP.
  
  
  RESULTS
  We analyzed clinical and biological factors that could affect overall survival in noncastrate metastatic prostate cancer. We showed that normal or abnormal alkaline phosphatase at baseline might be useful in predicting survival.
authors.affiliation: Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France. Electronic address: gravisg@ipc.unicancer.fr.
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Gravis
authors.affiliation: Biostatistics Department, Institut Paoli-Calmettes, and Aix-Marseille Université, UMR_S 912 (SESSTIM), Marseille, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Boher
authors.affiliation: Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
authors.affiliation: Medical Oncology Department, Centre François Baclesse-CHU Côte de Nacre, Caen, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Joly
authors.affiliation: Medical Oncology Department, Centre Hospitalier Les Oudairies, La Roche-sur-Yon, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Priou
authors.affiliation: Institut Paoli-Calmettes, and Aix-Marseille Université, UMR_S912 (SESSTIM), Marseille, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Marino
authors.affiliation: Radiotherapy Department, Clinique Pasteur, Toulouse, France.
authors.forename: Igor
authors.initials: I
authors.lastname: Latorzeff
authors.affiliation: Department of Medical Oncology, Centre Paul Papin, Angers, France.
authors.forename: Remy
authors.initials: R
authors.lastname: Delva
authors.affiliation: Medical Oncology Department, Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Krakowski
authors.affiliation: Medical Oncology Department, Centre Eugène Marquis, Rennes, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Laguerre
authors.affiliation: Surgical Urology Department, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Jochen
authors.initials: J
authors.lastname: Walz
authors.affiliation: Medical Oncology Department, Centre René Gauducheau, Saint-Herblain, France.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Rolland
authors.affiliation: Medical Oncology Department, Hôpital Foch, Suresnes, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Théodore
authors.affiliation: Medical Oncology Department, Groupe Hospitalier Saint Joseph, Paris, France.
authors.forename: Gael
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authors.lastname: Deplanque
authors.affiliation: Medical Oncology Department, Centre Antoine Lacassagne, Nice, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Ferrero
authors.affiliation: Medical Oncology Department, Centre Val d'Aurelle-Paul Lamarque, Montpellier, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Pouessel
authors.affiliation: Medical Oncology Department, Institut Claudius Régaud, Toulouse, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Mourey
authors.affiliation: Medical Oncology Department, Institut Curie, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beuzeboc
authors.affiliation: Medical Oncology Department, Centre Georges François Leclerc, Dijon, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Zanetta
authors.affiliation: R&D UNICANCER, Paris cedex 13, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Habibian
authors.affiliation: Medical Oncology Department, Clinique Sainte Marguerite, Hyeres, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Berdah
authors.affiliation: Medical Oncology Department, Hôpital Layné, Mont de Marsan, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Dauba
authors.affiliation: Medical Oncology Department, Centre Hospitalier La Timone, Marseille, France.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Baciuchka
authors.affiliation: Medical Oncology Department, Centre Régional Hospitalier, Metz-Thionville, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Platini
authors.affiliation: Medical Oncology Department, Hôpital Bretonneau, Tours, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Linassier
authors.affiliation: Medical Oncology Department, Centre Hospitalier Dupuytren, Limoges, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Labourey
authors.affiliation: Medical Oncology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Jean Pascal
authors.initials: JP
authors.lastname: Machiels
authors.affiliation: Medical Oncology Department, Centre Catherine de Sienne, Nantes, France.
authors.forename: Claude
authors.initials: C
authors.lastname: El Kouri
authors.affiliation: Medical Oncology Department, Hôpital Saint-André, Bordeaux, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Ravaud
authors.affiliation: Medical Oncology Department, Clinique Saint-Jean Languedoc, Toulouse, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Suc
authors.affiliation: Medical Oncology Department, Institut Jean Godinot, Reims, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Eymard
authors.affiliation: Medical Oncology Department, Clinique Armoricaine de Radiologie, Saint-Brieux, France.
authors.forename: Ali
authors.initials: A
authors.lastname: Hasbini
authors.affiliation: Medical Oncology Department, Hôpital Saint-Louis, Paris, France.
authors.forename: Guilhem
authors.initials: G
authors.lastname: Bousquet
authors.affiliation: Urology Department, Centre Hospitalier Universitaire Rangueil, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Soulie
authors.affiliation: Medical Oncology Department, Georges Pompidou Hospital and Rene Descartes University, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Oudard
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary*; D003661:Decision Support Techniques; D000077143:Docetaxel; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D009919:Orchiectomy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D043823:Taxoids / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D043823:Taxoids; D000077143:Docetaxel; D000469:Alkaline Phosphatase
keywords: Alkaline phosphatase; Docetaxel; Metastatic; Noncastrate; Prognostic factors; Prostate cancer