Precise Prognosis Analysis Of Metastatic Castration Resistant Prostate Cancer

Objective : To explore the prognostic factors of patients with metastatic castration-resistant prostate cancer(mCRPC)in order to achieve individualized prognostic evaluation and guide individualized treatment.Methods: The clinical data and peripheral blood samples from 279 mCRPC patients from January 2013 to January 2017 were collected retrospectively.The independent prognostic predictors of mCRPC patients were measured by Cox regression.A new prognostic model was established by adding the newly discovered independent predictors to the traditional prognostic model in order to increase the accuracy of prognostic prediction.Results:For mCRPC patients treating with abiraterone(AA),those with baseline high neuroendocrine(NED)markers and NED markers elevation after 3 months of AA treatment had significantly worse prognosis.Multivariate analysis showed that the baseline NED markers and the NED markers variation were independent prognostic predictors.Low pre-albumin level at baseline and low prognostic Nutritional Index(PNI)were independent predictors of adverse outcomes in mCRPC patients.The accuracy of prognostic prediction was significantly increased by incorporating these indices into traditional predictive models.TRIM59 gene was associated with castration resistance and NED progression,and patients with high expression had poor prognosis.Conclution:Patients with high level of NED marker before AA treatment and the elevation after AA treatment were indicated to not effective to AA.The variation of PNI level after AA treatment is helpful to judge the initial response to AA,serum prealbumin level and PNI level at baseline is important to predict the prognosis of mCRPC patients.At the same time,the pre-albumin and PNI levels are important supplement to the traditional prognostic model.TRIM59 gene was associated with castration resistance and NED progression,and patients with high expression had poor prognosis.