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Prognostic value of anemia in untreated metastatic prostate cancer: a multivariate analysis of SWOG 8894.

4574 Background: The association of anemia with shorter survival in untreated metastatic prostate cancer may simply reflect extent of disease. We examined the prognostic value of anemia in a multivariate analysis that included disease extent and other demographic covariates in patients starting hormonal therapy for metastatic prostate cancer.


METHODS
Pre-treatment hemoglobin (HGB) and complete covariate information were available for 957 patients. The multivariate association of covariates with anemia (HGB < 12 g/dL) was evaluated with a logistic regression model. The associations between HGB and survival (S) and progression-free survival (PFS) were evaluated using a proportional hazards model and included indicators for quartiles of HGB and baseline covariates. PSA normalization (PSAN=PSA ≤ 4 ng/ml) was evaluated with a logistic model.


RESULTS
Quartiles of HGB were: Q1: ≤ 10.1, Q2: 10.2-12.0, Q3: 12.1-13.4, Q4: > 13.4 g/dL. In a multivariate model, anemia (≤ 12 g/dl) was significantly associated (p< 0.02) with being African American, PS 2-3 (vs. 0-1), extensive disease, and higher PSA; inversely associated with prior therapy with curative intent and with Gleason score 6-7 (vs. ≤5); and not associated with age or bone pain. Higher HGB was significantly associated with longer S and PFS and higher likelihood of PSAN with hormonal therapy, and longer time to non-prostate cancer death. After adjusting for potential confounders, higher HGB remained a significant predictor (p<0.01) of S, PFS, and PSAN. [Figure: see text] Conclusions: In this untreated metastatic prostate cancer population, anemia (HGB<12 g/dL) is seen in 50% of patients at study entry and is associated with shorter survival, shorter progression-free survival, and lower likelihood of PSA normalization with hormonal therapy after adjustment for disease status and other covariates. No significant financial relationships to disclose.