Predictors of skeletal-related events and mortality in men with metastatic, castration-resistant prostate cancer

Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database

Ingrid Lorese Tablazon, Lauren E. Howard, Amanda M. De Hoedt, William J. Aronson, Christopher J. Kane, Christopher L. Amling, Matthew R. Cooperberg, Martha K. Terris, Stephen J. Freedland, Stephen Williams

    Research output: Contribution to journalArticle

    Abstract

    Background: Although skeletal-related events (SREs) are linked with a reduced quality of life and worse outcomes, to the authors' knowledge the factors that predict SREs are minimally understood. The objective of the current study was to identify predictors of SREs and all-cause mortality among men with metastatic castration-resistant prostate cancer (mCRPC). Methods: Data were collected on 837 men with bone mCRPC at 8 Veterans Affairs medical centers within the Shared Equal Access Regional Cancer Hospital (SEARCH) database from 2000 through 2017. Patients were followed to assess development of SREs (pathological fracture, radiotherapy to bone, spinal cord compression, or surgery to bone). Cox proportional hazards models were used to evaluate predictors of SREs and mortality. Results: Of the 837 men with bone mCRPC, 287 developed a SRE and 740 men died (median follow-up, 26 months). Bone pain was found to be the strongest predictor of SREs (hazard ratio [HR], 2.96; 95% CI, 2.25-3.89). A shorter time from CRPC to the development of metastasis (HR, 0.92; 95% CI, 0.85-0.99), shorter progression to CRPC (HR, 0.94; 95% CI, 0.91-0.98), and visceral metastasis at the time of diagnosis of bone metastasis (HR, 1.91; 95% CI, 1.18-3.09) were associated with an increased risk of SREs. Ten or more bone metastases (HR, 2.17; 95% CI, 1.72-2.74), undergoing radical prostatectomy (HR, 0.73; 95% CI, 0.61-0.89), shorter progression to CRPC (HR, 0.97; 95% CI, 0.94-0.99), older age (HR, 1.03; 95% CI, 1.02-1.04), higher prostate-specific antigen level at the time of diagnosis of metastasis (HR, 1.21; 95% CI, 1.14-1.28), bone pain (HR, 1.44; 95% CI, 1.23-1.70), and visceral metastasis (HR, 1.72; 95% CI, 1.23-2.39) were associated with an increased mortality risk. Conclusions: Among men with bone mCRPC, bone pain was found to be the strongest predictor of SREs and the number of bone metastases was a strong predictor of mortality. If validated, these factors potentially may be used for risk stratification and for SRE prevention strategies.

    Original languageEnglish (US)
    JournalCancer
    DOIs
    StateAccepted/In press - Jan 1 2019

    Fingerprint

    Cancer Care Facilities
    Castration
    Prostatic Neoplasms
    Databases
    Bone and Bones
    Mortality
    Neoplasm Metastasis
    Pain
    Bone Neoplasms
    Spontaneous Fractures
    Spinal Cord Compression
    Veterans
    Prostate-Specific Antigen
    Prostatectomy
    Proportional Hazards Models
    Radiotherapy
    Quality of Life

    Keywords

    • bone
    • metastasis
    • predictors
    • prostate cancer
    • Shared Equal Access Regional Cancer Hospital (SEARCH)
    • skeletal events

    ASJC Scopus subject areas

    • Oncology
    • Cancer Research

    Cite this

    Predictors of skeletal-related events and mortality in men with metastatic, castration-resistant prostate cancer : Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. / Tablazon, Ingrid Lorese; Howard, Lauren E.; De Hoedt, Amanda M.; Aronson, William J.; Kane, Christopher J.; Amling, Christopher L.; Cooperberg, Matthew R.; Terris, Martha K.; Freedland, Stephen J.; Williams, Stephen.

    In: Cancer, 01.01.2019.

    Research output: Contribution to journalArticle

    Tablazon, Ingrid Lorese ; Howard, Lauren E. ; De Hoedt, Amanda M. ; Aronson, William J. ; Kane, Christopher J. ; Amling, Christopher L. ; Cooperberg, Matthew R. ; Terris, Martha K. ; Freedland, Stephen J. ; Williams, Stephen. / Predictors of skeletal-related events and mortality in men with metastatic, castration-resistant prostate cancer : Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. In: Cancer. 2019.
    @article{e22916f9d5b44b41924aae52076e2113,
    title = "Predictors of skeletal-related events and mortality in men with metastatic, castration-resistant prostate cancer: Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database",
    abstract = "Background: Although skeletal-related events (SREs) are linked with a reduced quality of life and worse outcomes, to the authors' knowledge the factors that predict SREs are minimally understood. The objective of the current study was to identify predictors of SREs and all-cause mortality among men with metastatic castration-resistant prostate cancer (mCRPC). Methods: Data were collected on 837 men with bone mCRPC at 8 Veterans Affairs medical centers within the Shared Equal Access Regional Cancer Hospital (SEARCH) database from 2000 through 2017. Patients were followed to assess development of SREs (pathological fracture, radiotherapy to bone, spinal cord compression, or surgery to bone). Cox proportional hazards models were used to evaluate predictors of SREs and mortality. Results: Of the 837 men with bone mCRPC, 287 developed a SRE and 740 men died (median follow-up, 26 months). Bone pain was found to be the strongest predictor of SREs (hazard ratio [HR], 2.96; 95{\%} CI, 2.25-3.89). A shorter time from CRPC to the development of metastasis (HR, 0.92; 95{\%} CI, 0.85-0.99), shorter progression to CRPC (HR, 0.94; 95{\%} CI, 0.91-0.98), and visceral metastasis at the time of diagnosis of bone metastasis (HR, 1.91; 95{\%} CI, 1.18-3.09) were associated with an increased risk of SREs. Ten or more bone metastases (HR, 2.17; 95{\%} CI, 1.72-2.74), undergoing radical prostatectomy (HR, 0.73; 95{\%} CI, 0.61-0.89), shorter progression to CRPC (HR, 0.97; 95{\%} CI, 0.94-0.99), older age (HR, 1.03; 95{\%} CI, 1.02-1.04), higher prostate-specific antigen level at the time of diagnosis of metastasis (HR, 1.21; 95{\%} CI, 1.14-1.28), bone pain (HR, 1.44; 95{\%} CI, 1.23-1.70), and visceral metastasis (HR, 1.72; 95{\%} CI, 1.23-2.39) were associated with an increased mortality risk. Conclusions: Among men with bone mCRPC, bone pain was found to be the strongest predictor of SREs and the number of bone metastases was a strong predictor of mortality. If validated, these factors potentially may be used for risk stratification and for SRE prevention strategies.",
    keywords = "bone, metastasis, predictors, prostate cancer, Shared Equal Access Regional Cancer Hospital (SEARCH), skeletal events",
    author = "Tablazon, {Ingrid Lorese} and Howard, {Lauren E.} and {De Hoedt}, {Amanda M.} and Aronson, {William J.} and Kane, {Christopher J.} and Amling, {Christopher L.} and Cooperberg, {Matthew R.} and Terris, {Martha K.} and Freedland, {Stephen J.} and Stephen Williams",
    year = "2019",
    month = "1",
    day = "1",
    doi = "10.1002/cncr.32414",
    language = "English (US)",
    journal = "Cancer",
    issn = "0008-543X",
    publisher = "John Wiley and Sons Inc.",

    }

    TY - JOUR

    T1 - Predictors of skeletal-related events and mortality in men with metastatic, castration-resistant prostate cancer

    T2 - Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database

    AU - Tablazon, Ingrid Lorese

    AU - Howard, Lauren E.

    AU - De Hoedt, Amanda M.

    AU - Aronson, William J.

    AU - Kane, Christopher J.

    AU - Amling, Christopher L.

    AU - Cooperberg, Matthew R.

    AU - Terris, Martha K.

    AU - Freedland, Stephen J.

    AU - Williams, Stephen

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - Background: Although skeletal-related events (SREs) are linked with a reduced quality of life and worse outcomes, to the authors' knowledge the factors that predict SREs are minimally understood. The objective of the current study was to identify predictors of SREs and all-cause mortality among men with metastatic castration-resistant prostate cancer (mCRPC). Methods: Data were collected on 837 men with bone mCRPC at 8 Veterans Affairs medical centers within the Shared Equal Access Regional Cancer Hospital (SEARCH) database from 2000 through 2017. Patients were followed to assess development of SREs (pathological fracture, radiotherapy to bone, spinal cord compression, or surgery to bone). Cox proportional hazards models were used to evaluate predictors of SREs and mortality. Results: Of the 837 men with bone mCRPC, 287 developed a SRE and 740 men died (median follow-up, 26 months). Bone pain was found to be the strongest predictor of SREs (hazard ratio [HR], 2.96; 95% CI, 2.25-3.89). A shorter time from CRPC to the development of metastasis (HR, 0.92; 95% CI, 0.85-0.99), shorter progression to CRPC (HR, 0.94; 95% CI, 0.91-0.98), and visceral metastasis at the time of diagnosis of bone metastasis (HR, 1.91; 95% CI, 1.18-3.09) were associated with an increased risk of SREs. Ten or more bone metastases (HR, 2.17; 95% CI, 1.72-2.74), undergoing radical prostatectomy (HR, 0.73; 95% CI, 0.61-0.89), shorter progression to CRPC (HR, 0.97; 95% CI, 0.94-0.99), older age (HR, 1.03; 95% CI, 1.02-1.04), higher prostate-specific antigen level at the time of diagnosis of metastasis (HR, 1.21; 95% CI, 1.14-1.28), bone pain (HR, 1.44; 95% CI, 1.23-1.70), and visceral metastasis (HR, 1.72; 95% CI, 1.23-2.39) were associated with an increased mortality risk. Conclusions: Among men with bone mCRPC, bone pain was found to be the strongest predictor of SREs and the number of bone metastases was a strong predictor of mortality. If validated, these factors potentially may be used for risk stratification and for SRE prevention strategies.

    AB - Background: Although skeletal-related events (SREs) are linked with a reduced quality of life and worse outcomes, to the authors' knowledge the factors that predict SREs are minimally understood. The objective of the current study was to identify predictors of SREs and all-cause mortality among men with metastatic castration-resistant prostate cancer (mCRPC). Methods: Data were collected on 837 men with bone mCRPC at 8 Veterans Affairs medical centers within the Shared Equal Access Regional Cancer Hospital (SEARCH) database from 2000 through 2017. Patients were followed to assess development of SREs (pathological fracture, radiotherapy to bone, spinal cord compression, or surgery to bone). Cox proportional hazards models were used to evaluate predictors of SREs and mortality. Results: Of the 837 men with bone mCRPC, 287 developed a SRE and 740 men died (median follow-up, 26 months). Bone pain was found to be the strongest predictor of SREs (hazard ratio [HR], 2.96; 95% CI, 2.25-3.89). A shorter time from CRPC to the development of metastasis (HR, 0.92; 95% CI, 0.85-0.99), shorter progression to CRPC (HR, 0.94; 95% CI, 0.91-0.98), and visceral metastasis at the time of diagnosis of bone metastasis (HR, 1.91; 95% CI, 1.18-3.09) were associated with an increased risk of SREs. Ten or more bone metastases (HR, 2.17; 95% CI, 1.72-2.74), undergoing radical prostatectomy (HR, 0.73; 95% CI, 0.61-0.89), shorter progression to CRPC (HR, 0.97; 95% CI, 0.94-0.99), older age (HR, 1.03; 95% CI, 1.02-1.04), higher prostate-specific antigen level at the time of diagnosis of metastasis (HR, 1.21; 95% CI, 1.14-1.28), bone pain (HR, 1.44; 95% CI, 1.23-1.70), and visceral metastasis (HR, 1.72; 95% CI, 1.23-2.39) were associated with an increased mortality risk. Conclusions: Among men with bone mCRPC, bone pain was found to be the strongest predictor of SREs and the number of bone metastases was a strong predictor of mortality. If validated, these factors potentially may be used for risk stratification and for SRE prevention strategies.

    KW - bone

    KW - metastasis

    KW - predictors

    KW - prostate cancer

    KW - Shared Equal Access Regional Cancer Hospital (SEARCH)

    KW - skeletal events

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    U2 - 10.1002/cncr.32414

    DO - 10.1002/cncr.32414

    M3 - Article

    JO - Cancer

    JF - Cancer

    SN - 0008-543X

    ER -