Collette et alwhen the factor <strong>of</strong> bone involvement was <strong>for</strong>ced out <strong>of</strong> themodel, alkaline phosphatase was significant and accounted<strong>for</strong> about half the effect assigned to the bone scan in ourmodel. Albumin and LDH, visceral disease, and Gleasonscore were not collected in the EORTC studies. <strong>With</strong>outthese variables, we could not assess directly the extra precisionthat the addition <strong>of</strong> HRQOL would bring when addedto the models <strong>of</strong> Halabi et al or Smaletz et al. There<strong>for</strong>e, wecompared the ROC AUC <strong>of</strong> the five-factor model containingHRQOL factors with that <strong>of</strong> the best prediction modelthat could be developed on our database when using onlythe clinical and biochemical factors. This simplified modelincluded only WHO per<strong>for</strong>mance status, hemoglobin, andthe number <strong>of</strong> hot spots on the bone scan and achieved aROC AUC <strong>of</strong> 0.63. This was lower than the ROC AUCsachieved by the two nomograms, which could be anticipatedfrom important factors in the models <strong>of</strong> Halabi et aland Smaletz et al not being available in the EORTC database.Nevertheless, it demonstrates that the addition <strong>of</strong> theHRQOL component to the three-factor model adds only1% to the model predictive ability. This is very little and isless than what is obtained by adding clinical in<strong>for</strong>mationsuch as Gleason sum, alkaline phosphatase, or LDH in thetwo nomograms.From this, we conclude that HRQOL factors, even ifthey have been shown to be independent prognostic factorsin several studies including ours, are not particularly useful<strong>for</strong> predicting the overall survival <strong>of</strong> individual HRPC patientsonce clinical and biochemical factors are taken intoaccount. Given the extra burden they require and the littleextra precision they bring to these predictions, we suggestthat models based on clinical and biochemical factorsshould be used whenever all the factors are available fromroutine practice. When they are not available, only a roughprediction may be obtained on the basis <strong>of</strong> HRQOL factorsonly. However, our study shows that other prognostic factorsshould be investigated to further increase the predictiveability <strong>of</strong> the existing prediction models proposed by Halabiet al 13 and Smaletz et al. 12 In that search, the statisticalsignificance <strong>of</strong> the new factors should not be the only focus,and there must be a careful assessment <strong>of</strong> the predictiveability <strong>of</strong> the models and <strong>of</strong> the extra precision to the predictionsthat is achieved when the new factors are added toexisting models.■ ■ ■Acknowledgment and AppendixThe acknowledgment and appendix are included in thefull-text version <strong>of</strong> this article, available online at www.jco.org. They are not included in the PDF (via Adobe® AcrobatReader®) version.Authors’ Disclosures <strong>of</strong> PotentialConflicts <strong>of</strong> InterestThe following authors or their immediate familymembers have indicated a financial interest. No conflictexists <strong>for</strong> drugs or devices used in a study if they are notbeing evaluated as part <strong>of</strong> the investigation. Consultant/Advisory Role: Sophie D. Fossa, Bayer. Research Funding:Sophie D. Fossa, Aventis. For a detailed description<strong>of</strong> these categories, or <strong>for</strong> more in<strong>for</strong>mation about theAmerican Society <strong>of</strong> Clinical Oncology’s conflict <strong>of</strong> interestpolicy, please refer to the Author Disclosure Declaration<strong>for</strong>m and the Disclosures <strong>of</strong> Potential Conflicts<strong>of</strong> Interest section <strong>of</strong> In<strong>for</strong>mation <strong>for</strong> Contributorsfound in the front <strong>of</strong> every issue.REFERENCES1. Eisenberger MA: Chemotherapy <strong>for</strong> endocrineresistant cancer <strong>of</strong> the prostate. Prog ClinBiol Res 359:155-164, 19902. 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