Min Gyeong Eun, Ahn Hanjong
Department of Urology, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea.
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea.
Oncol Lett. 2017 Jun;13(6):4832-4836. doi: 10.3892/ol.2017.6056. Epub 2017 Apr 20.
The present study evaluated androgen deprivation methods to determine the approach that most improves the progression-free survival (PFS) of patients with metastatic prostate cancer. Patients had received continuous maximal androgen blockade (MAB) or monotherapy [luteinizing-hormone releasing hormone (LHRH) agonist or orchiectomy] following the reaching of the prostate specific antigen (PSA) nadir. The medical records of 293 patients who received MAB following a diagnosis of metastatic prostate cancer were retrospectively reviewed. Following attainment of the PSA nadir and treatment with MAB, patients were maintained on continuous MAB (group CMAB) or converted to monotherapy (group MONO). Disease progression, defined as progression to castration-resistant prostate cancer, was evaluated and compared between the treatment modalities. PFS was compared between patients who received CMAB vs. MONO using 2:1 (102:53) propensity score matching; the basic clinicopathological characteristics (age, Gleason score, PSA and extent of bone metastasis) were similar between the groups. Disease progression was observed in 70.9% of all patients, with a median treatment period of 22.7 months. The median PFS time was 19.5 months in the CMAB group and 28.8 months in the MONO group (P=0.008). Kaplan-Meier analysis demonstrated that PFS was significantly associated with the type of maintenance androgen deprivation therapy (ADT; log rank <0.005). Multivariate analysis revealed that the type of maintenance ADT and the pretreatment extent of bone metastasis were independent predictors of prolonged PFS. In this propensity score matched-analysis, conversion to monotherapy with a LHRH agonist or orchiectomy following attainment of the PSA nadir with initial MAB, prolonged the PFS, suggesting that monotherapy maintenance following initial MAB may benefit patients by reducing side effects without decreasing treatment efficacy.
本研究评估了雄激素剥夺方法，以确定最能改善转移性前列腺癌患者无进展生存期（PFS）的方法。在前列腺特异性抗原（PSA）降至最低点后，患者接受了持续最大雄激素阻断（MAB）或单一疗法[促黄体激素释放激素（LHRH）激动剂或睾丸切除术]。对293例诊断为转移性前列腺癌后接受MAB治疗的患者的病历进行了回顾性分析。在PSA降至最低点并接受MAB治疗后，患者继续接受持续MAB治疗（CMAB组）或转为单一疗法（MONO组）。评估并比较了两种治疗方式下疾病进展情况，疾病进展定义为进展为去势抵抗性前列腺癌。使用2:1（102:53）倾向评分匹配法比较接受CMAB与MONO治疗的患者的PFS；两组间基本临床病理特征（年龄、Gleason评分、PSA和骨转移范围）相似。所有患者中有70.9%观察到疾病进展，中位治疗期为22.7个月。CMAB组的中位PFS时间为19.5个月，MONO组为28.8个月（P = 0.008）。Kaplan-Meier分析表明，PFS与维持雄激素剥夺治疗（ADT）的类型显著相关（对数秩<0.005）。多变量分析显示，维持ADT的类型和骨转移的预处理范围是PFS延长的独立预测因素。在这项倾向评分匹配分析中，在初始MAB治疗使PSA降至最低点后转为使用LHRH激动剂或睾丸切除术进行单一疗法，可延长PFS，这表明初始MAB治疗后采用单一疗法维持治疗可能通过减少副作用而不降低治疗效果使患者受益。
