ECOG Score Predicts Survival Across Metastatic Prostate Cancer Settings


While ECOG performance status proves crucial for predicting survival in patients with metastatic prostate cancer, its specific impact on mCSPC needs further investigation.

PC-3 human prostate cancer cells: © heitipaves -

PC-3 human prostate cancer cells: © heitipaves -

A systematic review and meta-analysis of 75 studies found that ECOG performance status should be prioritized when assessing prognosis in patients with metastatic prostate cancer (mPC).1

A total of 32,298 patients were enrolled across the 75 studies, 72 of which included patients with metastatic castration-resistant prostate cancer (mCRPC). Findings showed that having worse ECOG performance status (≥2) significantly increased the risk of death in patients with mPC compared with those with better performance statuses (<2) (hazard ratio [HR], 2.10; 95% CI, 1.87-2.37).

Across 72 studies, ECOG performance status consistently emerged as a key predictor of overall survival (OS) regardless of prior chemotherapy. However, the magnitude of this association differed between real-world data and clinical trials as there was a higher risk estimate of mortality among patients with mCRPC with an ECOG performance status of ≥1 vs <1 in real-world data studies (HR, 1.98; 95% CI, 1.72-2.26) compared with clinical trials (HR, 1.32; 95% CI, 1.13-1.54; P <.001). This suggests the need for considering the study context when interpreting results.

“To our knowledge, this is the first systematic review and meta-analysis of the prognostic value of ECOG [performance status] on OS in the context of mPC alone. Overall, higher ECOG [performance status] scores were found to be associated with higher mortality risk, compared with lower ECOG [performance status] scores, but the highest mortality estimate was observed among patients with mCRPC with an ECOG [performance status] of ≥2 vs <2,” wrote study authors in findings published in Frontiers in Oncology.

From the start of the study through March 21, 2022, PubMed was searched for trials. Investigators performed a meta-analysis which pooled the effect of ECOG performance status categories on OS. This was done separately for studies which included patients with mCRPC and metastatic castration-sensitive prostate cancer (mCSPC) using a random-effects model. These analyses were stratified by study type and previous chemotherapy.

Among the 4,686 studies identified, 75 studies were selected for analysis after applying for the inclusion and exclusion criteria.

Overall findings showed that among all subpopulations included in the analyses, a higher ECOG performance status was linked with a statistically significant increase in mortality risk vs those with a lower ECOG performance status. Significant differences between the pooled HRs were observed when compared across all 3 ECOG performance status categories. (P =.046).

Looking at an ECOG performance status of ≥1 vs <1, patients with mCRPC had an HR for OS of 1.68 (95% CI, 1.44-1.94). The same comparison led to a numerically higher risk estimate of OS among patients with mCSPC (HR, 2.16; 95% CI, 1.43-3.25), but this difference did not reach statistical significance (P =.247).

Overall, this study provides both clinical trial and real-world data on the link between ECOG performance status and OS in prostate cancer. This can significantly improve care for patients with mPC by accounting for factors not always captured in readily available data sources.

“Future studies can incorporate these estimates in sensitivity analyses to better capture the effect of residual confounding when ECOG [performance status] data are missing in the context of mPC and mortality. Additional studies are needed to better characterize the risk of ECOG [performance status] on OS in the mCSPC setting, and to understand its role in other cancer populations and outcomes,” concluded the study authors.

Assayag J, Kim C, Chu H, Webster J. The prognostic value of Eastern Cooperative Oncology Group performance status on overall survival among patients with metastatic prostate cancer: a systematic review and meta-analysis. Front Oncol. 2023;13:1194718. Published 2023 Dec 15. doi:10.3389/fonc.2023.1194718

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