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Optimizing risk stratification for intermediate-risk prostate cancer – the prognostic value of baseline health-related quality of life

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Title: Optimizing risk stratification for intermediate-risk prostate cancer – the prognostic value of baseline health-related quality of life
Authors: Thilo Westhofen, Alexander Buchner, Simon Lennartz, Severin Rodler, Lennert Eismann, Can Aydogdu, Darjusch Askari-Motlagh, Elena Berg, Enya Feyerabend, Philipp Kazmierczak, Friedrich Jokisch, Armin Becker, Christian G. Stief, Alexander Kretschmer
Source: World J Urol
Publisher Information: Springer Science and Business Media LLC, 2024.
Publication Year: 2024
Subject Terms: Male, Prostatectomy, Survival Rate, Research, Quality of Life, Humans, Prostatic Neoplasms, EORTC QLQ-C30, Health-related quality of life, Aged [MeSH], Risk Assessment [MeSH], Prostatic Neoplasms/mortality [MeSH], Humans [MeSH], Prospective Studies [MeSH], Prostatic Neoplasms/pathology [MeSH], Middle Aged [MeSH], Radical prostatectomy, Survival Rate [MeSH], Metastasis-free survival, Male [MeSH], Risk stratification, Quality of Life [MeSH], Intermediate-risk prostate cancer, Prognosis [MeSH], Prostatic Neoplasms/psychology [MeSH], Prostatic Neoplasms/surgery [MeSH], Prostatectomy/methods [MeSH], Prospective Studies, Middle Aged, Prognosis, Risk Assessment, Aged
Description: Objective To investigate the prognostic value of baseline health-related quality of life (HRQOL) for patients with intermediate-risk localized prostate cancer (IR-PCa) undergoing radical prostatectomy (RP). Methods 4780 patients with IR-PCa according to NCCN risk stratification were identified from a prospectively maintained database. All patients were treated with RP and had prospectively assessed baseline HRQOL. Main outcomes were oncologic endpoints metastasis-free survival (MFS); biochemical recurrence free survival (BRFS) and overall survival (OS). Multivariable Cox regression models assessed prognostic significance of baseline global health status (GHS) on survival outcomes. Harrell’s discrimination C-index was applied to calculate the predictive accuracy of the model. Decision curve analysis (DCA) tested the clinical net benefit associated with adding the GHS domain to our multivariable model (p Results Median follow-up was 51 months. Multivariable analysis confirmed baseline GHS as an independent predictor for increased MFS (HR 0.976, 95%CI 0.96–0.99; p p = 0.027) and increased OS (HR 0.969, 95%CI 0.95–0.99; p = 0.002), indicating a relative risk reduction of 2.4% for MFS, 0.7% for BRFS and 3.1% for OS per 1-point increase of baseline GHS. Baseline HRQOL improved discrimination in predicting MFS, BRFS and OS. DCA revealed a net benefit over all threshold probabilities. Conclusions We found baseline HRQOL to substantially improve risk stratification for the heterogeneous cohort of IR-PCa. Baseline HRQOL accurately predicts increased MFS, BRFS and OS. Our findings therefore support the role of preoperative HRQOL as an adjunct to established prognosticators for IR-PCa, potentially facilitating guidance of therapy.
Document Type: Article
Other literature type
Language: English
ISSN: 1433-8726
DOI: 10.1007/s00345-024-05298-2
Access URL: https://pubmed.ncbi.nlm.nih.gov/39427278
https://repository.publisso.de/resource/frl:6495909
https://epub.ub.uni-muenchen.de/126278/
Rights: CC BY
Accession Number: edsair.doi.dedup.....1496061c073a9a1844cbd7b471f3fbf4
Database: OpenAIRE
Description
Abstract:Objective To investigate the prognostic value of baseline health-related quality of life (HRQOL) for patients with intermediate-risk localized prostate cancer (IR-PCa) undergoing radical prostatectomy (RP). Methods 4780 patients with IR-PCa according to NCCN risk stratification were identified from a prospectively maintained database. All patients were treated with RP and had prospectively assessed baseline HRQOL. Main outcomes were oncologic endpoints metastasis-free survival (MFS); biochemical recurrence free survival (BRFS) and overall survival (OS). Multivariable Cox regression models assessed prognostic significance of baseline global health status (GHS) on survival outcomes. Harrell’s discrimination C-index was applied to calculate the predictive accuracy of the model. Decision curve analysis (DCA) tested the clinical net benefit associated with adding the GHS domain to our multivariable model (p Results Median follow-up was 51 months. Multivariable analysis confirmed baseline GHS as an independent predictor for increased MFS (HR 0.976, 95%CI 0.96–0.99; p p = 0.027) and increased OS (HR 0.969, 95%CI 0.95–0.99; p = 0.002), indicating a relative risk reduction of 2.4% for MFS, 0.7% for BRFS and 3.1% for OS per 1-point increase of baseline GHS. Baseline HRQOL improved discrimination in predicting MFS, BRFS and OS. DCA revealed a net benefit over all threshold probabilities. Conclusions We found baseline HRQOL to substantially improve risk stratification for the heterogeneous cohort of IR-PCa. Baseline HRQOL accurately predicts increased MFS, BRFS and OS. Our findings therefore support the role of preoperative HRQOL as an adjunct to established prognosticators for IR-PCa, potentially facilitating guidance of therapy.
ISSN:14338726
DOI:10.1007/s00345-024-05298-2