Objective: We examined the prognostic value of chronic pulmonary disease (CPD), which can cause hypoxemic hypoxia possibly resulting in tumor hypoxia, in patients with advanced prostate cancer (APC).
Methods: We evaluated 295 patients with APC who had initially received androgen deprivation therapy. The progression to hormone refractory prostate cancer (HRPC), and the overall and disease specific survival were analyzed; the relationship to clinicopathological variables, including the presence of CPD, result of pulmonary function tests (PFT), smoking history and hemoglobin level were evaluated by the Kaplan-Meier method. A multivariate analysis was then performed according to the Cox regression model.
Results: The median time to HRPC was 14 and 38 months in patients with and without CPD, respectively (P = 0.001). The median overall survival from diagnosis was 51 and 81 months (P = 0.007), and the median disease specific survival was 56 and 135 months, respectively (P = 0.008). A univariate analysis showed that the result of PFT was a significant variable for progression to HRPC. In addition, the hemoglobin level (11.4 g/dl, 25th percentile) was a significant variable for overall and disease specific survival. As a result of the multivariate analysis, the presence of CPD was an independent prognostic variable for progression to HRPC, as were the Gleason score and stage. As well, CPD was an independent prognostic variable for overall and disease specific survival, as were alkaline phosphatase levels and nadir PSA.
Conclusion: Our findings strongly implicate CPD as a factor that contributes to a poor prognosis in patients with APC.