Department of Urology Graduate School of Medicine, Chiba University, Chiba, Japan
Junryo Rii , Shinichi Sakamoto , Yasutaka Yamada , Yusuke Imamura , Kazuyoshi Nakamura , Akira Komiya , Hiroomi Nakatsu , Tomohiko Ichikawa
Background: The oligometastatic cancer has been suggested as an intermediate state between localized disease and wide range metastases. Clinical significance of local treatment in oligometastatic prostate cancer (PCa) has been a recent topic. However, due to racial differences, there are no standard definitions of oligometastasis, especially in Asians. Here we studied the risk factor among Japanese oligometastatic PCa patients. Methods: We retrospectively analyzed the medical record of 207 patients, including locally advanced (T3 or T4N0M0), lymph-node-positive (N1), and ≤10 bone metastases cancer. All patients received androgen deprivation therapy only. The number of bone metastasis and clinical factors were evaluated in association with OS. Results: Median age, PSA at baseline and OS were 73 years, 48.8ng/ml and 121 months respectively. The cutoff value for the number of bone metastases that have the greatest impact on OS was ≥2 (HR 3.05, p = 0.0001), followed by ≥7 (HR 3.03, p = 0.0005). In multivariate analysis, lymph node metastasis (HR 2.54, p = 0.003) and ≥2 bone metastases (HR 2.67, p = 0.009) were independent predictors of OS. In risk classification based on independent predictors, OS was significantly classified in High (3-4 factors), Intermediate (1-2 factors), and Low (no factor) risk groups (p <0.0001). Furthermore, even among same risk factors group, inclusion of lymph node metastasis significantly increased the HR by 2.34 (p = 0.039). Conclusions: Not only the number of bone metastasis but also lymph node metastasis predict OS of oligometastatic PCa patients.
Characteristic | Cut off | Univariate analysis | Multivariate analysis | ||||||
---|---|---|---|---|---|---|---|---|---|
HR | Lower 95% | Upper 95% | P value | HR | Lower 95% | Upper 95% | P value | ||
Age | ≥73y | 1.30 | 0.73 | 2.28 | 0.36 | - | - | - | - |
PSA | ≥ 48.8 ng/mL | 1.10 | 0.62 | 1.91 | 0.74 | - | - | - | - |
Hb | ≤ 13.8 g/dL | 1.44 | 0.82 | 2.55 | 0.20 | - | - | - | - |
Alb | ≤4.3 g/dL | 1.74 | 0.97 | 3.21 | 0.061 | - | - | - | - |
Alkaline phosphatase | ≥251 IU/L | 2.34 | 1.28 | 4.53 | 0.005 | 1.69 | 0.90 | 3.38 | 0.11 |
Gleason score | ≥8 | 2.29 | 1.10 | 5.60 | 0.027 | 1.31 | 0.49 | 3.77 | 0.60 |
Lymph node metastasis | +/- | 3.22 | 1.84 | 5.76 | 0.0003 | 2.54 | 1.34 | 4.99 | 0.003 |
Visceral metastasis | +/- | 1.01 | 0.24 | 2.76 | 0.98 | - | - | - | - |
Bone metastasis number | ≥2 | 3.05 | 1.72 | 5.62 | 0.0001 | 2.67 | 1.16 | 6.00 | 0.009 |
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