{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T20:49:01Z","timestamp":1787086141157,"version":"build-2736575974"},"reference-count":50,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T00:00:00Z","timestamp":1738281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The prognostic value of baseline clinical parameters in predicting the survival prolonging effect of Radium-223-dichloride (223RaCl2) for metastatic castration resistant prostate cancer (mCRPC) patients has been the object of intensive research and remains an open issue. This national multicenter study aimed to corroborate the evidence of ten years of clinical experience with 223RaCl2 by collecting data from eight Italian Nuclear Medicine Units. Methods: Data from 581 consecutive mCRPC patients treated with 223RaCl2 were retrospectively analyzed. Several baseline variables relevant to the overall survival (OS) analysis were considered, including age, previous radical prostatectomy\/radiotherapy, number of previous treatment lines, prior chemotherapy, Gleason score, presence of lymphoadenopaties, number of bone metastases, concomitant use of bisphosphonates\/Denosumab, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), as well as baseline values of hemoglobin (Hb), platelets, Total Alkaline Phosphatase (tALP), Lactate Dehydrogenase (LDH), and Prostate-Specific Antigen (PSA). Data were summarized using descriptive statistics, univariate analysis and multivariate analysis with the Cox model. Results: The median OS time was 14 months (95%CI 12\u201317 months). At univariate analysis age, the number of previous treatment lines, number of bone metastases, ECOG-PS, presence of lymphadenopathies at the time of enrollment, as well as baseline tALP, PSA, and Hb, were independently associated with OS. After multivariate analysis, the number of previous treatment lines (HR = 1.1670, CI = 1.0095\u20131.3491, p = 0.0368), the prior chemotherapy (HR = 0.6461, CI = 0.4372\u20130.9549, p = 0.0284), the presence of lymphadenopathies (HR = 1.5083, CI = 1.1210\u20132.0296, p = 0.0066), the number of bone metastases (HR = 0.6990, CI = 0.5416\u20130.9020, p = 0.0059), ECOG-PS (HR = 1.3551, CI = 1.1238\u20131.6339, p = 0.0015), and baseline values of tALP (HR = 1.0008, CI = 1.0003\u20131.0013, p = 0.0016) and PSA (HR = 1.0004, CI = 1.0002\u20131.0006, p = 0.0005) remained statistically significant. Conclusions: In the era of precision medicine and in the landscape of novel therapies for mCRPC, the prognostic stratification of patients undergoing 223RaCl2 has a fundamental role for clinical decision-making, ranging from treatment choice to optimal sequencing and potential associations. This large Italian multicenter study corroborated the prognostic value of several variables, emerging from ten years of clinical experience with 223RaCl2.<\/jats:p>","DOI":"10.3390\/diagnostics15030339","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T09:16:26Z","timestamp":1738314986000},"page":"339","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Large Italian Multicenter Study on Prognostic Value of Baselines Variables in mCRPC Patients Treated with 223RaCl2: Ten Years of Clinical Experience"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3216-4838","authenticated-orcid":false,"given":"Maria Silvia","family":"De Feo","sequence":"first","affiliation":[{"name":"Department of Radiological Sciences, Oncology and Anatomo Pathology, Sapienza, University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4423-5496","authenticated-orcid":false,"given":"Luca","family":"Filippi","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, Via Montpellier 1, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1937-9116","authenticated-orcid":false,"given":"Matteo","family":"Bauckneht","sequence":"additional","affiliation":[{"name":"Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2412-5807","authenticated-orcid":false,"given":"Elisa","family":"Lodi Rizzini","sequence":"additional","affiliation":[{"name":"Radiation Oncology, IRCSS Azienza Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0168-8551","authenticated-orcid":false,"given":"Cristina","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Lavelli","sequence":"additional","affiliation":[{"name":"Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7038-3615","authenticated-orcid":false,"given":"Andrea","family":"Marongiu","sequence":"additional","affiliation":[{"name":"Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manlio","family":"Mascia","sequence":"additional","affiliation":[{"name":"Radiopharmacy Section, Ospedale G. 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