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Comorbidity and Survival of Prostate Cancer D3 patients

Cogswell J, Badin S, Oliphant TL, Hoover D, Chang VT. Comorbidity and Survival of Prostate Cancer D3 patients. Paper presented at: American Society of Clinical Oncology Annual Meeting; 2008 May 30; Chicago, IL.




Abstract:

Background: We studied whether comorbidity indices can add to survival prediction in patients with hormone refractory prostate cancer. Methods: In an IRB approved protocol, records of patients with hormone refractory prostate cancer seen between 2000 and 2005 were reviewed for demographics, laboratory values, and follow-up. Comorbidity was assessed with three co-morbidity indices, the Charlson Comorbidity Index (CMI), the Kaplan-Feinstein Comorbidity Index (KFI), and the Cumulative Illness Rating Scale (CIRS). Stage D3 diagnosis was made when patients on hormonal therapy had rising PSA and progression on imaging studies. Univariate and multivariate survival models were constructed using the Gleason grade, serum lactate dehydrogenase (LDH), alkaline phosphatase (AlkPhos), hemoglobin (hgb), and prostate specific antigen (PSA). The number of radiation and chemotherapy treatments was tabulated. Results: There were 46 pts. The m age at diagnosis was 76(range 61–94) m Gleason 7(4–10) m LDH 197(111–9962) m alkaline phosphatase 138(26–3850) m PSA 74(0.5–57,643) m Hgb.12.2(6.1–15.5). Of these pts, 41 (89%) had died. M survival was 300 days (6–2646). M values for the CMI 10.45 (8–14), KFI 2 (0–3), CIRS15 4.5 (1–10), CIRS 16 8 (2–15), and CIRS 17 1.65 (1–2.7). Fifteen (33%) patients did not receive any further treatments, 16 pts (35%) received one treatment, 11 pts (24%) received 2 treatments, 3 pts (6%) 3 treatments, and 1 pt (2%) 4 treatments. In univariate analyses, albumin (p < 0.001), LDH (p < 0.019), Hgb (p < 0.063), alk phos (p < 0.001) were significant predictors. In multivariate analyses, serum alkaline phosphatase (p < 0.045), Gleason (p < 0.045), and albumin (p < 0.001) were significant predictors, but not the comorbidity indices. The presence of comorbidity did not affect the likelihood of receiving treatments. Conclusions: In this small sample, comorbidity indices were not an independent predictor of survival. Further work needs to be done in larger samples of patients.





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