A Novel Radiographic Pattern Related to Poor Prognosis in Patients with Prostate Cancer with Metastatic Spinal Cord Compression
(2023) In European Urology Open Science 48. p.44-53- Abstract
Background: Prostate cancer spinal bone metastases can have a radiographic profile that mimics multiple myeloma. Objective: To analyse the presence and prognostic value of myeloma-like prostate cancer bone metastases and its relation to known clinical, molecular, and morphological prognostic markers. Design, setting, and participants: A cohort of 110 patients with prostate cancer who underwent surgery for metastatic spinal cord compression (MSCC) was analysed. Spinal bone metastases were classified as myeloma like (n = 20) or non–myeloma like (n = 90) based on magnetic resonance imaging prior to surgery. An immunohistochemical analysis of metastasis samples was performed to assess tumour cell proliferation (percentage of Ki67-positive... (More)
Background: Prostate cancer spinal bone metastases can have a radiographic profile that mimics multiple myeloma. Objective: To analyse the presence and prognostic value of myeloma-like prostate cancer bone metastases and its relation to known clinical, molecular, and morphological prognostic markers. Design, setting, and participants: A cohort of 110 patients with prostate cancer who underwent surgery for metastatic spinal cord compression (MSCC) was analysed. Spinal bone metastases were classified as myeloma like (n = 20) or non–myeloma like (n = 90) based on magnetic resonance imaging prior to surgery. An immunohistochemical analysis of metastasis samples was performed to assess tumour cell proliferation (percentage of Ki67-positive cells) and the expression levels of prostate-specific antigen (PSA) and androgen receptor (AR). The metastasis subtypes MetA, MetB, and MetC were determined from transcriptomic profiling. Outcome measurements and statistical analysis: Survival curves were compared with the log-rank test. Univariate and multivariate Cox proportional hazard models were used to assess the effects of prognostic variables. Groups were compared using the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Results and limitations: Patients with the myeloma-like metastatic pattern had median survival after surgery for MSCC of 1.7 (range 0.1–33) mo, while the median survival period of those with the non–myeloma-like pattern was 13 (range 0–140) mo (p < 0.001). The myeloma-like appearance had an independent prognostic value for the risk of death after MSCC surgery (adjusted hazard ratio 2.4, p = 0.012). Postoperative neurological function was significantly reduced in the myeloma-like group. No association was found between the myeloma-like pattern and morphological markers of known relevance for this patient group: the transcriptomic subtypes MetA, MetB, and MetC; tumour cell proliferation; and AR and PSA expression. Conclusions: A myeloma-like metastatic pattern identifies an important subtype of metastatic prostate cancer associated with poor survival and neurological outcomes after surgery for MSCC. Patient summary: This study describes a novel radiographic pattern of prostate cancer bone metastases and its relation to poor patient prognosis.
(Less)
- author
- Wänman, Johan ; Abul-Kasim, Kasim LU ; Semenas, Julius ; Thysell, Elin ; Bergh, Anders ; Wikström, Pernilla and Crnalic, Sead
- organization
- publishing date
- 2023-02
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Metastatic spinal cord compression, Myeloma-like prostate cancer bone metastases, Prostate cancer
- in
- European Urology Open Science
- volume
- 48
- pages
- 10 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85144765610
- pmid:36743403
- ISSN
- 2666-1691
- DOI
- 10.1016/j.euros.2022.12.004
- language
- English
- LU publication?
- yes
- id
- ef118777-a143-4823-bba5-9d9127046f65
- date added to LUP
- 2023-02-02 10:25:06
- date last changed
- 2025-10-14 12:13:34
@article{ef118777-a143-4823-bba5-9d9127046f65,
abstract = {{<p>Background: Prostate cancer spinal bone metastases can have a radiographic profile that mimics multiple myeloma. Objective: To analyse the presence and prognostic value of myeloma-like prostate cancer bone metastases and its relation to known clinical, molecular, and morphological prognostic markers. Design, setting, and participants: A cohort of 110 patients with prostate cancer who underwent surgery for metastatic spinal cord compression (MSCC) was analysed. Spinal bone metastases were classified as myeloma like (n = 20) or non–myeloma like (n = 90) based on magnetic resonance imaging prior to surgery. An immunohistochemical analysis of metastasis samples was performed to assess tumour cell proliferation (percentage of Ki67-positive cells) and the expression levels of prostate-specific antigen (PSA) and androgen receptor (AR). The metastasis subtypes MetA, MetB, and MetC were determined from transcriptomic profiling. Outcome measurements and statistical analysis: Survival curves were compared with the log-rank test. Univariate and multivariate Cox proportional hazard models were used to assess the effects of prognostic variables. Groups were compared using the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Results and limitations: Patients with the myeloma-like metastatic pattern had median survival after surgery for MSCC of 1.7 (range 0.1–33) mo, while the median survival period of those with the non–myeloma-like pattern was 13 (range 0–140) mo (p < 0.001). The myeloma-like appearance had an independent prognostic value for the risk of death after MSCC surgery (adjusted hazard ratio 2.4, p = 0.012). Postoperative neurological function was significantly reduced in the myeloma-like group. No association was found between the myeloma-like pattern and morphological markers of known relevance for this patient group: the transcriptomic subtypes MetA, MetB, and MetC; tumour cell proliferation; and AR and PSA expression. Conclusions: A myeloma-like metastatic pattern identifies an important subtype of metastatic prostate cancer associated with poor survival and neurological outcomes after surgery for MSCC. Patient summary: This study describes a novel radiographic pattern of prostate cancer bone metastases and its relation to poor patient prognosis.</p>}},
author = {{Wänman, Johan and Abul-Kasim, Kasim and Semenas, Julius and Thysell, Elin and Bergh, Anders and Wikström, Pernilla and Crnalic, Sead}},
issn = {{2666-1691}},
keywords = {{Metastatic spinal cord compression; Myeloma-like prostate cancer bone metastases; Prostate cancer}},
language = {{eng}},
pages = {{44--53}},
publisher = {{Elsevier}},
series = {{European Urology Open Science}},
title = {{A Novel Radiographic Pattern Related to Poor Prognosis in Patients with Prostate Cancer with Metastatic Spinal Cord Compression}},
url = {{http://dx.doi.org/10.1016/j.euros.2022.12.004}},
doi = {{10.1016/j.euros.2022.12.004}},
volume = {{48}},
year = {{2023}},
}