Factors predicting skeletal-related events in patients with bone metastatic castration-resistant prostate cancer

Zachary W A Klaassen, Lauren E. Howard, Amanda de Hoedt, Christopher L. Amling, William J. Aronson, Matthew R. Cooperberg, Christopher J. Kane, Martha Kennedy Terris, Stephen J. Freedland

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Skeletal-related events (SREs) are common complications of bone metastatic castration-resistant prostate cancer (mCRPC). To the authors' knowledge, there are limited data regarding which factors predict SREs. The authors identified risk factors for SREs in men with bone mCRPC using characteristics commonly available in the medical record. METHODS: Data from 454 patients with nonmetastatic CRPC were identified from 2 Veteran Affairs Medical Centers from 2000 through 2013. Among these men, 233 (51%) developed bone metastases during follow-up and represented the study cohort. First occurrence of an SRE was abstracted from the medical records. A stepwise multivariable Cox model was used to select the strongest predictors of time to SRE. RESULTS: The median age of the patients at the time of diagnosis of bone mCRPC was 75 years (interquartile range, 68-81 years), and there were 153 nonblack patients (66%). During follow-up (median, 7.8 months [interquartile range, 2.9-18.3 months]), 88 patients (38%) had an SRE. On univariable analysis, more recent year of metastasis (hazard ratio [HR], 0.91), prostate-specific antigen doubling time of ≥9 months versus <9 months (HR, 0.50), and bone pain (HR, 3.34) were all found to be associated with SRE risk. On multivariable analysis, year of metastasis (HR, 0.93), biopsy Gleason score of 7 versus ≤6 (HR, 1.74), radiotherapy as the primary localized treatment versus none (HR, 2.33), and bone pain (HR, 3.64) were associated with SRE risk. The area under the curve for a multivariable model based upon these risk factors was 0.744. CONCLUSIONS: The authors identified several significant predictors of SREs among men with mCRPC. In particular, men with bone pain are at high risk of an SRE. If confirmed, future trials should focus on prolonging life and reducing SRE risk in patients with mCRPC with bone pain. Cancer 2017;123:1528–1535.

Original languageEnglish (US)
Pages (from-to)1528-1535
Number of pages8
JournalCancer
Volume123
Issue number9
DOIs
StatePublished - May 1 2017

Fingerprint

Castration
Prostatic Neoplasms
Bone and Bones
Pain
Neoplasm Metastasis
Medical Records
Bone Neoplasms
Neoplasm Grading
Veterans
Prostate-Specific Antigen
Proportional Hazards Models
Area Under Curve
Radiotherapy
Biopsy
Neoplasms

Keywords

  • bone metastases
  • bone pain
  • metastatic castration-resistant prostate cancer (mCRPC)
  • prostate cancer
  • skeletal-related event (SRE)

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Klaassen, Z. W. A., Howard, L. E., de Hoedt, A., Amling, C. L., Aronson, W. J., Cooperberg, M. R., ... Freedland, S. J. (2017). Factors predicting skeletal-related events in patients with bone metastatic castration-resistant prostate cancer. Cancer, 123(9), 1528-1535. https://doi.org/10.1002/cncr.30505

Factors predicting skeletal-related events in patients with bone metastatic castration-resistant prostate cancer. / Klaassen, Zachary W A; Howard, Lauren E.; de Hoedt, Amanda; Amling, Christopher L.; Aronson, William J.; Cooperberg, Matthew R.; Kane, Christopher J.; Terris, Martha Kennedy; Freedland, Stephen J.

In: Cancer, Vol. 123, No. 9, 01.05.2017, p. 1528-1535.

Research output: Contribution to journalArticle

Klaassen, ZWA, Howard, LE, de Hoedt, A, Amling, CL, Aronson, WJ, Cooperberg, MR, Kane, CJ, Terris, MK & Freedland, SJ 2017, 'Factors predicting skeletal-related events in patients with bone metastatic castration-resistant prostate cancer', Cancer, vol. 123, no. 9, pp. 1528-1535. https://doi.org/10.1002/cncr.30505
Klaassen, Zachary W A ; Howard, Lauren E. ; de Hoedt, Amanda ; Amling, Christopher L. ; Aronson, William J. ; Cooperberg, Matthew R. ; Kane, Christopher J. ; Terris, Martha Kennedy ; Freedland, Stephen J. / Factors predicting skeletal-related events in patients with bone metastatic castration-resistant prostate cancer. In: Cancer. 2017 ; Vol. 123, No. 9. pp. 1528-1535.
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abstract = "BACKGROUND: Skeletal-related events (SREs) are common complications of bone metastatic castration-resistant prostate cancer (mCRPC). To the authors' knowledge, there are limited data regarding which factors predict SREs. The authors identified risk factors for SREs in men with bone mCRPC using characteristics commonly available in the medical record. METHODS: Data from 454 patients with nonmetastatic CRPC were identified from 2 Veteran Affairs Medical Centers from 2000 through 2013. Among these men, 233 (51{\%}) developed bone metastases during follow-up and represented the study cohort. First occurrence of an SRE was abstracted from the medical records. A stepwise multivariable Cox model was used to select the strongest predictors of time to SRE. RESULTS: The median age of the patients at the time of diagnosis of bone mCRPC was 75 years (interquartile range, 68-81 years), and there were 153 nonblack patients (66{\%}). During follow-up (median, 7.8 months [interquartile range, 2.9-18.3 months]), 88 patients (38{\%}) had an SRE. On univariable analysis, more recent year of metastasis (hazard ratio [HR], 0.91), prostate-specific antigen doubling time of ≥9 months versus <9 months (HR, 0.50), and bone pain (HR, 3.34) were all found to be associated with SRE risk. On multivariable analysis, year of metastasis (HR, 0.93), biopsy Gleason score of 7 versus ≤6 (HR, 1.74), radiotherapy as the primary localized treatment versus none (HR, 2.33), and bone pain (HR, 3.64) were associated with SRE risk. The area under the curve for a multivariable model based upon these risk factors was 0.744. CONCLUSIONS: The authors identified several significant predictors of SREs among men with mCRPC. In particular, men with bone pain are at high risk of an SRE. If confirmed, future trials should focus on prolonging life and reducing SRE risk in patients with mCRPC with bone pain. Cancer 2017;123:1528–1535.",
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AU - Howard, Lauren E.

AU - de Hoedt, Amanda

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AU - Aronson, William J.

AU - Cooperberg, Matthew R.

AU - Kane, Christopher J.

AU - Terris, Martha Kennedy

AU - Freedland, Stephen J.

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N2 - BACKGROUND: Skeletal-related events (SREs) are common complications of bone metastatic castration-resistant prostate cancer (mCRPC). To the authors' knowledge, there are limited data regarding which factors predict SREs. The authors identified risk factors for SREs in men with bone mCRPC using characteristics commonly available in the medical record. METHODS: Data from 454 patients with nonmetastatic CRPC were identified from 2 Veteran Affairs Medical Centers from 2000 through 2013. Among these men, 233 (51%) developed bone metastases during follow-up and represented the study cohort. First occurrence of an SRE was abstracted from the medical records. A stepwise multivariable Cox model was used to select the strongest predictors of time to SRE. RESULTS: The median age of the patients at the time of diagnosis of bone mCRPC was 75 years (interquartile range, 68-81 years), and there were 153 nonblack patients (66%). During follow-up (median, 7.8 months [interquartile range, 2.9-18.3 months]), 88 patients (38%) had an SRE. On univariable analysis, more recent year of metastasis (hazard ratio [HR], 0.91), prostate-specific antigen doubling time of ≥9 months versus <9 months (HR, 0.50), and bone pain (HR, 3.34) were all found to be associated with SRE risk. On multivariable analysis, year of metastasis (HR, 0.93), biopsy Gleason score of 7 versus ≤6 (HR, 1.74), radiotherapy as the primary localized treatment versus none (HR, 2.33), and bone pain (HR, 3.64) were associated with SRE risk. The area under the curve for a multivariable model based upon these risk factors was 0.744. CONCLUSIONS: The authors identified several significant predictors of SREs among men with mCRPC. In particular, men with bone pain are at high risk of an SRE. If confirmed, future trials should focus on prolonging life and reducing SRE risk in patients with mCRPC with bone pain. Cancer 2017;123:1528–1535.

AB - BACKGROUND: Skeletal-related events (SREs) are common complications of bone metastatic castration-resistant prostate cancer (mCRPC). To the authors' knowledge, there are limited data regarding which factors predict SREs. The authors identified risk factors for SREs in men with bone mCRPC using characteristics commonly available in the medical record. METHODS: Data from 454 patients with nonmetastatic CRPC were identified from 2 Veteran Affairs Medical Centers from 2000 through 2013. Among these men, 233 (51%) developed bone metastases during follow-up and represented the study cohort. First occurrence of an SRE was abstracted from the medical records. A stepwise multivariable Cox model was used to select the strongest predictors of time to SRE. RESULTS: The median age of the patients at the time of diagnosis of bone mCRPC was 75 years (interquartile range, 68-81 years), and there were 153 nonblack patients (66%). During follow-up (median, 7.8 months [interquartile range, 2.9-18.3 months]), 88 patients (38%) had an SRE. On univariable analysis, more recent year of metastasis (hazard ratio [HR], 0.91), prostate-specific antigen doubling time of ≥9 months versus <9 months (HR, 0.50), and bone pain (HR, 3.34) were all found to be associated with SRE risk. On multivariable analysis, year of metastasis (HR, 0.93), biopsy Gleason score of 7 versus ≤6 (HR, 1.74), radiotherapy as the primary localized treatment versus none (HR, 2.33), and bone pain (HR, 3.64) were associated with SRE risk. The area under the curve for a multivariable model based upon these risk factors was 0.744. CONCLUSIONS: The authors identified several significant predictors of SREs among men with mCRPC. In particular, men with bone pain are at high risk of an SRE. If confirmed, future trials should focus on prolonging life and reducing SRE risk in patients with mCRPC with bone pain. Cancer 2017;123:1528–1535.

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