title: Survival predictors in patients with prostate adenocarcinoma with hormonal blockade.
abstract: Ki-67 index and clinical-pathological factors such as the Gleason score and the presence of neuroendocrine differentiation have been used for predicting survival in patients with prostate cancer. We examined prostate tissue from 45 patients with advanced prostate cancer who were treated with maximal androgen blockade and analysed their cancer-specific survival (CSS). We assessed the Gleason index, performed an immunohistochemical analysis of Ki-67 (MIB-1) and determined the presence of neuroendocrine differentiation (chromogranin A). A survival study was conducted using Kaplan-Meier curves (log-rank test) and a Cox regression analysis. Twenty-four patients (53.3%) died from the disease, with a mean follow-up of 68.7±7.7 months (56.6% CSS at 5 years and 31.8% at 10 years). In the univariate analysis, survival was associated with an interquartile distribution of Ki-67 (0-5, 6-12%, 13-25%, >25%; log-rank, p=0.01), Gleason 5 (total index 9-10; log-rank, p=0.002) and the presence of metastases during the diagnosis (M1; log-rank, p=0.004) but not to cT category (T3-T4; log-rank, p=0.26) or neuroendocrine differentiation (immunohistochemically positive tumour cell nests; log-rank, p=0.46). The multivariate analysis revealed that a Ki-67 index ≤12% (HR, 0.22; p=0.0009) and the absence of metastases (M0) during diagnosis (HR, 0.17; p=0.0002) were protective factors in this population. In conclusion, Ki-67 proliferation index and the lack of metastases at diagnosis predict CSS in patients with advanced prostate cancer who undergo hormonal blockade. Neuroendocrine differentiation in tumour tissue had no prognostic value in this study.
authors: Clinical Department, Faculty of Biomedical Sciences, European University of Madrid, Laureate International Universities, Madrid, Spain; Department of Urology, University Hospital of Getafe, Madrid, Spain.
authors: Javier C
authors: JC
authors: Angulo
authors: Department of Urology, University Hospital of Getafe, Madrid, Spain.
authors: Cristina
authors: C
authors: Redondo
authors: Department of Urology, University Hospital Príncipe de Asturias, University of Alcala, Alcala de Henares, Madrid, Spain.
authors: Manuel
authors: M
authors: Sánchez-Chapado
authors: Department of Systems Biology, Biochemical and Molecular Biology Teaching Unit, University of Alcala, Alcala de Henares, Madrid, Spain.
authors: Begoña
authors: B
authors: Colás
authors: Department of Systems Biology, Biochemical and Molecular Biology Teaching Unit, University of Alcala, Alcala de Henares, Madrid, Spain.
authors: Santiago
authors: S
authors: Ropero
authors: Department of Pathology, Cruces University Hospital, BioCruces Institute, University of the Basque Country (UPV/EHU), Barakaldo, Bizkaia, Spain. Electronic address: joseignacio.lopez@osakidetza.eus.
authors: José I
authors: JI
authors: López
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate
chemical_list: D000726:Androgen Antagonists; D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen
keywords: Hormonal blockade; Ki-67 index; Neuroendocrine differentiation; Prognosis; Prostate cancer