Wong William W, Anderson Eric M, Mohammadi Homan, Daniels Thomas B, Schild Steve E, Keole Sameer R, Choo C Richard, Tzou Katherine S, Bryce Alan H, Ho Thai H, Quevedo Fernando J, Vora Sujay A
Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ.
Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ.
Clin Genitourin Cancer. 2017 Dec;15(6):e969-e975. doi: 10.1016/j.clgc.2017.04.016. Epub 2017 Apr 26.
Radium-223 (Ra) improves survival in patients with metastatic castration-resistant prostate cancer (mCRPC). This retrospective analysis was performed to better understand its efficacy in routine clinical practice and identify factors associated with survival.
Sixty-four patients with mCRPC who received Ra between 2013 and 2015 were the basis of this retrospective study. Clinical outcomes and patient characteristics were obtained. Potential prognostic factors for survival were evaluated by univariate analysis using the log-rank test and multivariate analysis using the Cox proportional hazard method.
The median survival was 12.9 months. Twenty-one patients (33%) developed a skeletal event, and the median time to the first skeletal event was 4.4 months. In univariate analysis, factors significantly associated with survival included: no prior chemotherapy, ≤ 5 bone metastases, baseline prostate-specific antigen (PSA) ≤ 36 ng/mL, baseline alkaline phosphatase (ALP) < 115 U/L, baseline hemoglobin > 12 g/dL, ALP response after Ra treatment, PSA decrease during Ra treatment, and absence of > 25% PSA increase during Ra treatment. In multivariate analysis, 4 factors remained significant: no prior chemotherapy, ≤ 5 bone metastases, baseline ALP < 115 U/L, and ALP response after Ra treatment.
When Ra is administered in routine clinical practice, clinical outcomes can be more variable than those reported in the randomized study owing to patient heterogeneity. Four factors were identified to be significantly associated with survival after Ra treatment. These pretreatment factors may be used as stratification factors in future studies to investigate whether Ra would be more effective for patients with newly diagnosed metastatic disease that is sensitive to androgen deprivation therapy.
镭-223（Ra）可提高转移性去势抵抗性前列腺癌（mCRPC）患者的生存率。进行这项回顾性分析是为了更好地了解其在常规临床实践中的疗效，并确定与生存相关的因素。
本回顾性研究以2013年至2015年间接受Ra治疗的64例mCRPC患者为基础。获取了临床结局和患者特征。使用对数秩检验通过单因素分析和使用Cox比例风险法通过多因素分析评估生存的潜在预后因素。
中位生存期为12.9个月。21例患者（33%）发生了骨事件，首次骨事件的中位时间为4.4个月。在单因素分析中，与生存显著相关的因素包括：未接受过先前化疗、骨转移灶≤5个、基线前列腺特异性抗原（PSA）≤36 ng/mL、基线碱性磷酸酶（ALP）<115 U/L、基线血红蛋白>12 g/dL、Ra治疗后ALP反应、Ra治疗期间PSA下降以及Ra治疗期间PSA升高未超过25%。在多因素分析中，4个因素仍然显著：未接受过先前化疗、骨转移灶≤5个、基线ALP<115 U/L以及Ra治疗后ALP反应。
在常规临床实践中给予Ra治疗时，由于患者的异质性，临床结局可能比随机研究报告的更具变异性。确定了4个因素与Ra治疗后的生存显著相关。这些预处理因素可在未来研究中用作分层因素，以调查Ra对于对雄激素剥夺治疗敏感的新诊断转移性疾病患者是否更有效。
