J Cancer 2017; 8(17):3448-3455. doi:10.7150/jca.21134

Research Paper

Serum Pre-Albumin Predicts the Clinical Outcome in Metastatic Castration-Resistant Prostate Cancer Patients Treated With Abiraterone

Liancheng Fan1*, Chenfei Chi1*, Sanwei Guo2*, Yanqing Wang1, Wen Cai1, Xiaoguang Shao1, Fan Xu1, Jiahua Pan1, Yinjie Zhu1, Xun Shangguan1, Zhixiang Xin1, Jianian Hu1, Hongyang Qian1, Shaowei Xie1, Rui Wang3, Lixin Zhou1, Baijun Dong1✉, Wei Xue1✉

1. Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127,China;
2. Department of Urology, Shanghai International Medical Center, No.4358 KangXin Awy, Shanghai 200000,China;
3. Shanghai Institute of Ultrasound in Medicine, Department of Ultrasonography, Shanghai Jiaotong University Affiliated No. 6 Hospital, Yishan Road 600, Shanghai 200233, PR China.
* Liancheng Fan, Chenfei Chi and Sanwei Guo contributed equally.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Fan L, Chi C, Guo S, Wang Y, Cai W, Shao X, Xu F, Pan J, Zhu Y, Shangguan X, Xin Z, Hu J, Qian H, Xie S, Wang R, Zhou L, Dong B, Xue W. Serum Pre-Albumin Predicts the Clinical Outcome in Metastatic Castration-Resistant Prostate Cancer Patients Treated With Abiraterone. J Cancer 2017; 8(17):3448-3455. doi:10.7150/jca.21134. Available from http://www.jcancer.org/v08p3448.htm

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Objective To determine the prognostic utility of serum pre-albumin in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone (AA).

Patients and Methods 112 chemotherapy pretreated or chemotherapy-naive patients were scheduled for systemic treatment with AA. Serum pre-albumin levels were measured before and after 3 months of AA treatment. Univariate and multivariate analyses were performed to determine prognostic factors that were associated with PSA progression-free survival (PSA-PFS), radiographic PFS (rPFS) and overall survival (OS). The Harrell concordance index with variables only or combined pre-albumin data were used to evaluate the prognostic accuracy.

Results The group of patients with baseline pre-albumin value ≥20mg/dL had a longer OS, PSA-PFS, rPFS than those with pre-albumin value <20mg/dL. Based on the values of pre-albumin before and after 3 months of AA treatment, we divided these patients into 4 groups: high-high, high-low, low-high and low-low group. High- high group showed a significantly better OS, PSA-PFS, rPFS than other 3 groups. In multivariate analysis, low pre-albumin level remained significant predictors of OS (HR, 13.2; P<0.001), rPFS (HR, 3.7; P=0.003) and PSA-PFS (HR, 8.7; P<0.001). The estimated c-index of the multivariate model for OS increased from 0.814 without pre-albumin to 0.845 when pre-albumin added.

Conclusion Low pretreatment serum pre-albumin is a negative independent prognosticator of survival outcomes in mCRPC treated with AA and also increases the accuracy of established prognostic model. Serial pre-albumin evaluation might help clinicians guide clinical treatment of mCRPC patients.

Keywords: Metastatic castration-resistant prostate cancer, abiraterone acetate, prognostic model, nutrition, pre-albumin.