title: Which Factors Predict Overall Survival in Patients With Metastatic Castration-Resistant Prostate Cancer Treated With Abiraterone Acetate Post-Docetaxel?
abstract: Abiraterone acetate (AA) increases overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel. However, survival time varies substantially between individuals. Our goal was to identify prognostic factors that better estimate OS.
  
  
  
  This is a retrospective multicentric analysis of 368 patients with mCRPC starting AA with prednisone after docetaxel. Cox proportional hazards statistics were applied. A multivariate model was constructed based on significant univariate predictors by using a manual stepwise forward and backward selection strategy. Model performance was determined by using receiver operating characteristic (ROC) curves.
  
  
  
  Univariate analysis identified 20 significant OS predictors. A multivariate model was constructed, based on 220 patients, incorporating 5 independent risk factors for decreased OS at the time of AA initiation: hemoglobin < 12 g/dL (hazard ratio [HR] 2.02), > 10 metastases (HR 1.80), ECOG performance status ≥ 2 (HR 1.88), radiographic progression (HR 1.50), and time since diagnosis < 90 months (HR 1.66, all P < .05). Patients were stratified into 3 groups: good (0-2 risk factors, median OS 22.6 months), intermediate (3 risk factors, median OS 13.9 months), and poor prognosis (4-5 risk factors, median OS 6.2 months). The area under the ROC curve based on the event "death by the time of median OS (13.3 months)" was 0.736 (95% confidence interval 0.670-0.803).
  
  
  
  We identified 5 readily available risk factors independently associated with decreased OS. The resulting model may be used for patient counseling in daily clinical practice, as well as patient stratification in clinical trials.
authors.affiliation: Department of Urology, Ghent University Hospital, Ghent, Belgium. Electronic address: charles.vanpraet@uzgent.be.
authors.forename: Charles
authors.initials: C
authors.lastname: Van Praet
authors.affiliation: Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rottey
authors.affiliation: Department of Medical Oncology, University Hospital Leuven, Leuven, Belgium.
authors.forename: Fransien
authors.initials: F
authors.lastname: Van Hende
authors.affiliation: Department of Medical Oncology, AZ Turnhout, Turnhout, Belgium.
authors.forename: Gino
authors.initials: G
authors.lastname: Pelgrims
authors.affiliation: Department of Medical Oncology, AZ Klina, Kalmthout, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Demey
authors.affiliation: Department of Medical Oncology, AZ Delta, Roeselare, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Van Aelst
authors.affiliation: Department of Medical Oncology, Imelda Hospital, Bonheiden, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Wynendaele
authors.affiliation: Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gil
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Schatteman
authors.affiliation: Department of Medical Oncology, Hopital De Jolimont, Haine Saint Paul, Belgium.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Filleul
authors.affiliation: Department of Medical Oncology, University Hospital Brussels, Jette, Belgium.
authors.forename: Denis
authors.initials: D
authors.lastname: Schallier
authors.affiliation: Department of Medical Oncology, Institut Roi Albert II, Cliniques universitaires Saint Luc, Brussels, Belgium.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Machiels
authors.affiliation: Department of Medical Oncology, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Schrijvers
authors.affiliation: Department of Medical Oncology, AZ Nikolaas, Sint-Niklaas, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Everaert
authors.affiliation: Department of Medical Oncology, CHU Dinant-Godinne, Yvoir, Belgium.
authors.forename: Lionel
authors.initials: L
authors.lastname: D'Hondt
authors.affiliation: Department of Urology, AZ Groeninge, Kortrijk, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Werbrouck
authors.affiliation: Department of Medical Oncology, ZNA Jan Palfijn, Merksem, Belgium.
authors.forename: Joanna
authors.initials: J
authors.lastname: Vermeij
authors.affiliation: Department of Medical Oncology, AZ Jessa, Hasselt, Belgium.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Mebis
authors.affiliation: Department of Medical Oncology, St Luc Bouge, Namur, Belgium.
authors.forename: Marylene
authors.initials: M
authors.lastname: Clausse
authors.affiliation: Department of Medical Oncology, UZA/AZ Monica, Antwerp, Belgium.
authors.forename: Marika
authors.initials: M
authors.lastname: Rasschaert
authors.affiliation: Department of Medical Oncology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium.
authors.forename: Joanna
authors.initials: J
authors.lastname: Van Erps
authors.affiliation: Department of Medical Oncology, AZ Sint-Trudo, Sint-Truiden, Belgium.
authors.forename: Jolanda
authors.initials: J
authors.lastname: Verheezen
authors.affiliation: Department of Urology, AZ Sint-Andries, Tielt, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Van Haverbeke
authors.affiliation: Department of Medical Oncology, Sainte-Elisabeth, Namur, Belgium.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Goeminne
authors.affiliation: Department of Urology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Lumen
mesh_terms: D000069501:Abiraterone Acetate / Q000627:therapeutic use*; D000368:Aged; D000077143:Docetaxel; D006801:Humans; D008297:Male; D011241:Prednisone / Q000627:therapeutic use*; D011379:Prognosis; D016016:Proportional Hazards Models; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy*; D012372:ROC Curve; D012189:Retrospective Studies; D016019:Survival Analysis; D043823:Taxoids / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D000069501:Abiraterone Acetate; D011241:Prednisone
keywords: Chemotherapy; Prognosis; Prostatic neoplasms; Steroids; Survival