Validation of the 3-variable prognostic score (3-PS) in mCRPC patients treated with 223 Radium-dichloride: a national mu
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ORIGINAL ARTICLE
Validation of the 3‑variable prognostic score (3‑PS) in mCRPC patients treated with 223Radium‑dichloride: a national multicenter study Viviana Frantellizzi1 · Fabio Monari2 · Manlio Mascia3 · Renato Costa4 · Giuseppe Rubini5 · Angela Spanu6 · Arianna Di Rocco7 · Elisa Lodi Rizzini8 · Luca Cindolo9 · Maria Licari4 · Valentina Lavelli5 · Susanna Nuvoli6 · Cristina De Angelis10 · Valeria Dionisi2 · Cristina Ferrari5 · Giuseppe De Vincentis10 Received: 30 March 2020 / Accepted: 3 July 2020 © The Author(s) 2020
Abstract Objective Radium-223 (223Ra) has been approved for treatment in patients with metastatic castration-resistant prostatic cancer (mCRPC) and bone metastasis. This α-emitting radionuclide has a beneficial effect on pain and is also capable to increase overall survival (OS). Several studies evaluated the prognostic value of different biomarkers at baseline, such as serum values, imaging parameters or pain. To date, however, clinicians lack a validated and simple system to assess which patients will most likely benefit from 223Ra treatment. The 3-variable prognostic score (3-PS), proposed in a single-center study in 2017 classifies patients in five prognostic groups with a specific OS. This study aims to validate the 3-PS in a larger multicenter population. Methods Four hundred and thirty mCRPC patients treated with 223Ra from six different centers were analyzed. The 3-PS score consists of the collection of baseline hemoglobin, prostatic specific antigen and Eastern cooperative oncology group performance status and was initially applied to the whole population (total group). The score was then validated on the 338 patient’s subgroup (clean group) obtained by subtracting the 92 patients enrolled for the original study of the 3-PS score. This purified group served as further validation evidence. Results Statistical analysis showed that the 3-PS score was valid on the total group as well as in the clean group as the AUC estimated (0.74) falls within the CI of the AUC calculated on the validation sample (95% CI 0.66–0.82). Conclusion This study confirms the validity of the 3-PS score for mCRPC patients. This score is simple, noninvasive and affordable and can be easily used to select patients that will most probably complete 223Ra treatment. In addition, this tool provides an exact estimate of life expectancy in terms of OS. Keywords 223Radium-dichloride · mCRPC · Overall survival · Prognostic score
* Viviana Frantellizzi [email protected] 1
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Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
Department of Molecular Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy
Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy
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Unit of Nuclear Medicine, “Spirito Santo” Hospital, Pescara, Italy
Nuclear Medicine Unit, S. Orsola-Malpigh
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