Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA.
Cancer. 2013 Aug 15;119(16):2990-8. doi: 10.1002/cncr.28102. Epub 2013 May 29.
This study sought to characterize Modern patients with castration-resistant prostate cancer (CRPC) and identify pretreatment clinical predictors of survival.
A cohort of men with CRPC with and without metastases (M) treated with secondary hormonal therapy (2eHT) and/or chemotherapy (CT) was identified from the authors' institutional database. Associations of patient and disease characteristics at diagnosis, at androgen-deprivation therapy (ADT) initiation, at CRPC index date, and survival were evaluated. CRPC index date was defined as the start date of either 2eHT or CT, whichever came first.
In the cohort of 622 men, 434 men (70%) had M-positive disease; 552 men (89%) received 2eHT and 70 men (11%) received CT as their initial CRPC treatment. There were 410 deaths (66%) at the time of analysis. Median overall survival (OS) was 35 months (quartile 1, quartile 3: 21 months, 61 months). In multivariate analyses, higher biopsy Gleason score, the presence of M at ADT initiation, shorter time from ADT start to CRPC, higher prostate-specific antigen and poorer Eastern Cooperative Oncology Group performance status at CRPC and M at CRPC were predictive of shorter OS. Interestingly, whereas some men with biopsy Gleason scores of 6 died of their disease (N = 42), they had a longer OS after CRPC compared with those with a Gleason score ≥ 7.
This large retrospective study of patients with CRPC in a tertiary cancer center shows that biopsy Gleason score of 6 is associated with a less aggressive CRPC course, and the impact that M at ADT initiation and CRPC have on outcome is quantified.
本研究旨在描述去势抵抗性前列腺癌（CRPC）患者的特征，并确定治疗前生存的临床预测因素。
从作者的机构数据库中确定了接受二线激素治疗（2eHT）和/或化疗（CT）的转移性（M）和非转移性（NM）CRPC 患者队列。评估了诊断时、开始去势治疗（ADT）时、CRPC 指数日期时以及生存时患者和疾病特征的相关性。CRPC 指数日期定义为开始 2eHT 或 CT 的最早日期。
在 622 名男性患者中，434 名男性（70%）患有 M 阳性疾病；552 名男性（89%）接受 2eHT，70 名男性（11%）接受 CT 作为初始 CRPC 治疗。在分析时，有 410 人死亡（66%）。中位总生存期（OS）为 35 个月（四分位间距 1，3：21 个月，61 个月）。在多变量分析中，活检 Gleason 评分较高、ADT 开始时存在 M、从 ADT 开始到 CRPC 的时间较短、CRPC 时前列腺特异性抗原和东部合作肿瘤学组表现状态较差以及 CRPC 时存在 M 与较短的 OS 相关。有趣的是，虽然一些活检 Gleason 评分为 6 的患者死于该疾病（N=42），但与 Gleason 评分≥7 的患者相比，他们在 CRPC 后具有更长的 OS。
这项对三级癌症中心 CRPC 患者的大型回顾性研究表明，活检 Gleason 评分 6 与侵袭性较低的 CRPC 病程相关，并量化了 ADT 开始时存在 M 和 CRPC 对结局的影响。
