老年營養風險指數作為轉移性去勢抵抗性前列腺癌患者
接受Docetaxel治療的預後指標
謝享宸、洪晟鈞、楊晨洸、王賢祥、裘坤元
台中榮民總醫院 外科部 泌尿外科
Geriatric Nutritional Risk Index as a Prognostic Marker for Patients with Metastatic CastrationResistant Prostate Cancer Receiving Docetaxel
Hsiang-Chen Hsieh, Sheng-Chun Hung, Cheng-Kuang Yang,
Jian-Ri Li, Shian-Shiang Wang, Kun-Yuan Chiu
Taichung Veterans General Hospital, Division of Urology, Department of Surgery, Taichung.
Purpose:
To investigate the prognostic efficacy of the Geriatric Nutritional Risk Index (GNRI) in patients with metastatic Castration–resistant Prostate Cancer (mCRPC) receiving docetaxel as the first line of treatment.
Materials and Methods:
We retrospectively reviewed patients who had been diagnosed with mCRPC and receiving first line docetaxel in Taichung Veterans General Hospital from 2006 to 2012. The GNRI at mCRPC was calculated using serum albumin and body mass index, with a poor nutritional status defined as GNRI < 92.0. Multivariate Cox-regression analysis was used to evaluate the risk of survival.
Results:
One-hundred seventy patients with mCRPC were included in the analysis. One-hundred twenty-five patients were of normal nutritional status (GNRI ≥ 92) and 45 patients were of poor nutritional status (GNRI < 92). The cumulative docetaxel dosage was 600 (360-1185) mg in the normal nutritional status group and 360 (127.5-660) mg in the poor nutritional status group (p<0.001). The median overall survival from mCRPC was 30.39 months in the good nutritional status group and 11.07 months in the poor nutritional status group (p of log rank<0.001). In a multivariate model, poor nutritional status was an independent risk factor in overall survival (Hazard Ratio [HR] =
5.37, 95% Confidence Interval [CI] 3.27-8.83), together with a high metastatic volume (HR=4.03, 95% CI 2.16-7.53) and docetaxel cumulative dosage (HR=0.999, 95% CI 0.999-0.9998).
Conclusions:
Poor nutritional status with a GNRI < 92 is associated with shorter progression free survival and overall survival in mCRPC patients treated with docetaxel. Metastatic volume and cumulative docetaxel dosage are also independent prognostic factors in overall survival.