Prognostic Factor Analysis and Nomogram Development in Castration-Resistant Prostate Cancer with Visceral Metastases...

Area of Science:

• Oncology
• Medical Imaging
• Biostatistics

Background:

• Castration-resistant prostate cancer (CRPC) with visceral metastases has a poor prognosis.
• Accurate prognostic tools are needed for risk stratification and treatment planning.

Purpose of the Study:

• To identify independent prognostic factors in CRPC patients with visceral metastases.
• To develop and validate a prognostic nomogram for individualized risk stratification.
• To generate a framework for selecting patients for radionuclide therapies.

Main Methods:

• Retrospective cohort study of 98 CRPC patients with visceral metastases.
• Collected demographics, tumor parameters, biomarkers, and treatment data.
• Used Kaplan-Meier analysis, Cox regression, and a six-factor prognostic nomogram; assessed with C-index and AUC.

Main Results:

• Identified six adverse prognostic factors for overall survival (OS): ECOG PS ≥2, multiorgan metastases, high alkaline phosphatase, low hemoglobin, low albumin, and low PSA decline.
• Median OS was 13.2 months, median PFS was 7.5 months.
• The nomogram showed good performance with a C-index of 0.712 for OS and 0.698 for PFS.

Conclusions:

• The six-factor nomogram provides a quantitative prognostic framework for CRPC patients with visceral metastases.
• This model is hypothesis-generating and requires prospective validation for radionuclide therapy selection (e.g., ¹⁷⁷Lu-PSMA-617, ²²³Ra).
• Integration with molecular biomarkers is crucial for future validation and treatment guidance.