Predicting Toxicities and Survival Outcomes in De Novo Metastatic Hormone-Sensitive Prostate Cancer Using Clinical Features, Routine Blood Tests and Their Early Variations

BACKGROUND: Conventional prognostic factors are typically assessed at diagnosis in metastatic hormone-sensitive prostate cancer (mHSPC). However, variations in vital signs and laboratory parameters occur during systemic treatment and may predict patients' prognosis and anticipate organ-specific toxicity development.

METHODS: This single-center retrospective study included 363 patients with de novo mHSPC treated between 2014 and 2023. Clinical and laboratory data were systematically collected from the hospital data warehouse, from treatment initiation through the following seven months. Variations in vital parameters and blood test results were graded using CTCAE V5.0 (dynamic variables). Cox regression analyses were performed to explore the impact of dynamic variables on progression-free survival (PFS) and overall survival (OS). Machine learning (ML) models (Support Vector Classifier, Random Forest, and LGBM Classifier) were developed to predict single organ-specific toxicities and to identify good and poor responders based on 7-month PSA levels, PFS and OS. We compared ML model performance when trained only on baseline factors (static models) with those integrating variables generated by vital sign and blood test monitoring within 3 and 7 months from treatment start (dynamic models).

RESULTS: Dynamic model failed to improve the prediction of single organ-specific toxicities. Univariable Cox analysis revealed that the development of hematological, liver, and kidney-related toxicity, as well as the development of electrolyte disturbances within 3 or 7 months, was associated with shorter PFS (p = 0.011, 0.007, 0.174, and 0.02, respectively) and/or OS (p = 0.001, 0.099, 0.012, and 0.001, respectively). In multivariable Cox analysis, increasing alkaline phosphatase levels (HR = 1.93, p = 0.009), decreasing albumin (HR = 1.92, p = 0.008) and development of hyponatremia (HR = 1.79, p = 0.033) were associated with a shorter OS. The combination of static and dynamic variables significantly improved the ability of ML models to identify poor responders (shorter PFS: AUC range 0.91-0.94 vs. 0.79-0.89).

CONCLUSIONS: The integration of conventional prognostic factors with the detection of significant changes in vital signs and blood tests occurring early during systemic treatment in patients with de novo mHSPC may enhance patient stratification and improve prediction of survival outcomes. Multicenter validation studies are needed to confirm these results.