Original articleSurvival predictors in patients with prostate adenocarcinoma with hormonal blockade

Ki-67 index and clinical-pathological factors such as the Gleason score and the presence of neuroendocrine differentiation have been used for predicting survival in patients with prostate cancer. We examined prostate tissue from 45 patients with advanced prostate cancer who were treated with maximal androgen blockade and analysed their cancer-specific survival (CSS). We assessed the Gleason index, performed an immunohistochemical analysis of Ki-67 (MIB-1) and determined the presence of neuroendocrine differentiation (chromogranin A). A survival study was conducted using Kaplan-Meier curves (log-rank test) and a Cox regression analysis. Twenty-four patients (53.3%) died from the disease, with a mean follow-up of 68.7 ± 7.7 months (56.6% CSS at 5 years and 31.8% at 10 years). In the univariate analysis, survival was associated with an interquartile distribution of Ki-67 (0-5, 6-12%, 13-25%, >25%; log-rank, p = 0.01), Gleason 5 (total index 9-10; log-rank, p = 0.002) and the presence of metastases during the diagnosis (M1; log-rank, p = 0.004) but not to cT category (T3-T4; log-rank, p = 0.26) or neuroendocrine differentiation (immunohistochemically positive tumour cell nests; log-rank, p = 0.46). The multivariate analysis revealed that a Ki-67 index ≤12% (HR, 0.22; p = 0.0009) and the absence of metastases (M0) during diagnosis (HR, 0.17; p = 0.0002) were protective factors in this population. In conclusion, Ki-67 proliferation index and the lack of metastases at diagnosis predict CSS in patients with advanced prostate cancer who undergo hormonal blockade. Neuroendocrine differentiation in tumour tissue had no prognostic value in this study.