Absence of independent prognostic impact of node status in M1 prostate cancer: implications from a SEER-based study
Lei Li1, Zhengbang Hu2, Chijin Li3
1Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Objective:
We aimed to evaluate the association between T stage, N stage, and Gleason score with OS in metastatic prostate cancer (mPCa) patients.
Methods:
Using the SEER database, we identified M1 prostate cancer patients. Kaplan-Meier survival analysis with Log-rank testing was performed, stratified by metastatic substages (M1a, M1b, M1c). Multivariable Cox regression models identified independent prognostic factors for overall survival (OS).
Results:
A total of 170 mPCa patients were included, 60.0% had Gleason score ≥ 8, 74.7% presented with T3-T4 disease (versus 25.3% with localized T1-T2 tumors), and metastatic distribution included 68.8% M1b, 17.6% M1a, and 13.5% M1c. M1c patients demonstrated significantly worse prognosis (p = 0.033). Subgroup analyses revealed that advanced T stage significantly correlated with reduced OS in the overall M1 cohort (p = 0.015), M1b (p = 0.018), and M1c subgroups (p = 0.004), but not in M1a (p = 0.226). Nodal status showed no significant association with OS in any subgroup (M1a: p = 0.252; M1b: p = 0.762; M1c: p = 0.616). On multivariable Cox analysis, Gleason score ≥ 8 (HR = 2.65, 95%CI 1.21-5.79, p = 0.014), T4 stage (HR = 3.04, 95%CI 1.17-7.90, p = 0.023), and M1c substage (HR = 6.27, 95%CI 1.61-24.39, p = 0.008) emerged as independent predictors of poor survival.
Conclusion:
Our study suggests that nodal staging may have limited biological rationale in PCa when synchronous distant metastases exist.
Insights
In metastatic prostate cancer (mPCa), higher Gleason scores and advanced T4 stage predict poorer overall survival (OS). Nodal status (N stage) did not significantly impact OS in patients with distant metastases.
Area of Science:
- Oncology
- Urologic Oncology
- Prostate Cancer Research
Background:
- Metastatic prostate cancer (mPCa) prognosis is influenced by various clinical factors.
- Understanding the prognostic significance of T stage, N stage, and Gleason score is crucial for treatment planning and patient counseling.
Purpose of the Study:
- To evaluate the association between T stage, N stage, and Gleason score with overall survival (OS) in patients with metastatic prostate cancer (mPCa).
- To identify independent prognostic factors for OS in mPCa.
Main Methods:
- Utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with M1 prostate cancer.
- Conducted Kaplan-Meier survival analysis with Log-rank testing, stratified by metastatic substages (M1a, M1b, M1c).
- Employed multivariable Cox regression models to determine independent prognostic factors for OS.
Main Results:
- Analysis of 170 mPCa patients revealed that M1c substage (p=0.033) was associated with significantly worse prognosis.
- Advanced T stage correlated with reduced OS across the overall M1 cohort, M1b, and M1c subgroups (p<0.05).
- Gleason score ≥8 (HR=2.65), T4 stage (HR=3.04), and M1c substage (HR=6.27) were independent predictors of poor survival.
Conclusions:
- Nodal staging appears to have limited prognostic value in prostate cancer (PCa) when distant metastases are present.
- Gleason score and T stage are significant prognostic indicators in mPCa, particularly T4 and higher Gleason scores.
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