The Added Value of Circulating Tumor Cell Enumeration to Standard Markers in Assessing Prognosis in a Metastatic Castration-Resistant Prostate Cancer Population.
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Date
2017-04-15ICR Author
Author
Heller, G
Fizazi, K
McCormack, R
Molina, A
MacLean, D
Webb, IJ
Saad, F
de Bono, JS
Scher, HI
Type
Journal Article
Metadata
Show full item recordAbstract
Purpose: Metastatic castration-resistant prostate cancer (mCRPC) is a heterogeneous disease for which better prognostic models for survival are needed. We examined the added value of circulating tumor cell (CTC) enumeration relative to common prognostic laboratory measures from patients with CRPC.Methods: Utility of CTC enumeration as a baseline and postbaseline prognostic biomarker was examined using data from two prospective randomized registration-directed trials (COU-AA-301 and ELM-PC4) within statistical models used to estimate risk for survival. Discrimination and calibration were used to measure model predictive accuracy and the added value for CTC enumeration in the context of a Cox model containing albumin, lactate dehydrogenase (LDH), PSA, hemoglobin, and alkaline phosphatase (ALK). Discrimination quantifies how accurately a risk model predicts short-term versus long-term survivors. Calibration measures the closeness of actual survival time to the predicted survival time.Results: Adding CTC enumeration to a model containing albumin, LDH, PSA, hemoglobin, and ALK ("ALPHA") improved its discriminatory power. The weighted c-index for ALPHA without CTCs was 0.72 (SE, 0.02) versus 0.75 (SE, 0.02) for ALPHA + CTCs. The increase in discrimination was restricted to the lower-risk cohort. In terms of calibration, adding CTCs produced a more accurate model-based prediction of patient survival. The absolute prediction error for ALPHA was 3.95 months (SE, 0.28) versus 3.75 months (SE, 0.22) for ALPHA + CTCs.Conclusions: Addition of CTC enumeration to standard measures provides more accurate assessment of patient risk in terms of baseline and postbaseline prognosis in the mCRPC population. Clin Cancer Res; 23(8); 1967-73. ©2016 AACR.
Collections
Subject
Humans
Imidazoles
Naphthalenes
Prednisolone
Antineoplastic Combined Chemotherapy Protocols
Prognosis
Treatment Outcome
Adult
Aged
Middle Aged
Male
Neoplastic Cells, Circulating
Kaplan-Meier Estimate
Prostatic Neoplasms, Castration-Resistant
Biomarkers, Tumor
Abiraterone Acetate
Research team
Prostate Cancer Targeted Therapy Group
Language
eng
Date accepted
2016-09-08
License start date
2017-04
Citation
Clinical cancer research : an official journal of the American Association for Cancer Research, 2017, 23 (8), pp. 1967 - 1973
Publisher
AMER ASSOC CANCER RESEARCH