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Published on: March 6, 2018
Bellmunt Risk Score as a Prognostic Tool in Metastatic Castration-Resistant Prostate Cancer Survival
Thomas Büttner1, Niklas Klümper1, Jörg Ellinger1
1Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany.
Importance:
Metastatic castration-resistant prostate cancer (mCRPC) is an incurable disease with a highly variable clinical course, necessitating robust prognostic tools to guide individualized patient management.
Objective:
To validate the prognostic ability of the Bellmunt Risk Score (BRS) for predicting survival in patients with mCRPC.
Design, Setting, And Participants:
For this prognostic study, a post hoc analysis was conducted of 2 international, multicenter, phase 3 randomized clinical trials of men (aged ≥18 years) with mCRPC (ACIS [first-line setting] and ELM-PC-5 [postdocetaxel setting]). The ACIS trial enrolled patients between December 2014 and August 2016. The ELM-PC-5 trial enrolled patients between October 2010 and February 2013. Data analyses were conducted between September 2024 and March 2025.
Exposure:
Baseline BRS (range, 0-3), calculated by assigning 1 point for each of 3 factors (Eastern Cooperative Oncology Group Performance Status score ≥1, hemoglobin level <10 g/dL, and liver metastases).
Main Outcomes And Measures:
The primary outcomes, overall survival (OS) and radiographic progression-free survival, were assessed via Kaplan-Meier and multivariable Cox proportional hazards regression analysis.
Results:
This analysis included 678 evaluable male participants from the ACIS trial (median age, 71 years [range, 48-92 years]) and 1078 from the ELM-PC-5 trial (median age, 70 years [range, 43-89 years]), for a total of 1756 participants. The median follow-up was 54.8 months (IQR, 51.5-58.4 months) in the ACIS trial and 10.7 months (IQR, 0.4-27.1 months) in the ELM-PC-5 trial. Having a higher BRS was consistently associated with unfavorable OS in both cohorts. In the ACIS trial, the median OS decreased from 42.2 months (95% CI, 35.7-46.7 months) for patients with a BRS of 0 to 9.1 months (95% CI, 3.7 months to not reached) for those with a BRS of 3. Adjusted hazard ratios (AHRs) for OS were 1.37 (95% CI, 1.12-1.67) for patients with a BRS of 1, 2.64 (95% CI, 1.89-3.69) for a BRS of 2, and 8.29 (95% CI, 2.57-26.78) for a BRS of 3 compared with those with a BRS of 0. In the ELM-PC-5 trial, the median OS decreased from 23.0 months (95% CI, 21.50 months to not reached) for patients with a BRS of 0 to 3.2 months (95% CI, 1.4-8.6 months) for those with a BRS of 3. AHRs for OS were 1.65 (95% CI, 1.31-2.07) for patients with a BRS of 1, 2.93 (95% CI, 2.22-3.87) for those with a BRS of 2, and 4.43 (95% CI, 2.65-7.40) for those with a BRS of 3 compared with those with a BRS of 0. The BRS remained a robust and independent prognostic factor for both outcomes in all multivariable models.
Conclusions And Relevance:
In this prognostic study of patients with mCRPC, the BRS was validated as a prognostic tool that provides clinically meaningful information across different treatment lines. Due to its simplicity, the BRS is a practical aid for guiding treatment decisions and facilitating prognostic discussions in routine clinical care.
