Bilen Mehmet Asim, Hess Kenneth R, Subudhi Sumit K, Aparicio Ana, Kim Jeri, Zurita-Saavedra Amado J, Araujo John C, Corn Paul G, Stover Jessica, Lin Sue-Hwa, Logothetis Christopher J, Tu Shi-Ming
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Road NE, B4301, Atlanta, GA, 30322, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Cancer Chemother Pharmacol. 2017 Sep;80(3):583-589. doi: 10.1007/s00280-017-3391-9. Epub 2017 Jul 20.
We evaluated the patterns of progression and determined clinical predictors of survival in patients with castration-resistant prostate cancer (CRPCa) who received sipuleucel-T.
We retrospectively analyzed 56 consecutive patients with asymptomatic or minimally symptomatic CRPCa treated with sipuleucel-T. Age, number of bone metastases, history of prior systemic treatment, and alkaline phosphatase level (ALP) were tested as predictors of survival in a multivariate Cox proportional hazards regression model. The Kaplan-Meier method was used to estimate event-free probabilities.
The 56 patients were a median age of 67 years (range 51-84 years). After sipuleucel-T treatment, 25 patients developed bone progression after a median of 22 months of follow-up (54% of patients were event free at 2 years) and 10% (6/56 patients) developed rapid progression. Eleven deaths were observed after a median of 28 months of follow-up. Forty-eight patients were included in the multivariate analysis for overall survival. The analysis showed that age >70 years (p = 0.012), number of bone metastases >20 (p = 0.018), prior systemic treatment (p = 0.018), and ALP level >90 IU/L (p = 0.010) significantly predicted worse overall survival. Two-year overall survival was 36% among the 16 patients with two or more of these factors and was 93% among the 32 patients with one or none of these factors (p = 0.0004).
CRPCa patients with age (>70 years), increased tumor burden in bone (>20 metastases and/or elevated ALP level), and/or prior systemic treatment are more likely to experience rapid deterioration after sipuleucel-T. These results need to be prospectively validated.
我们评估了接受西妥昔单抗治疗的去势抵抗性前列腺癌（CRPCa）患者的疾病进展模式，并确定了生存的临床预测因素。
我们回顾性分析了56例接受西妥昔单抗治疗的无症状或症状轻微的CRPCa患者。在多变量Cox比例风险回归模型中，对年龄、骨转移数量、既往全身治疗史和碱性磷酸酶水平（ALP）作为生存预测因素进行了检验。采用Kaplan-Meier方法估计无事件概率。
56例患者的中位年龄为67岁（范围51 - 84岁）。接受西妥昔单抗治疗后，25例患者在中位随访22个月后出现骨转移进展（2年时54%的患者无事件发生），10%（6/56例患者）出现快速进展。中位随访28个月后观察到11例死亡。48例患者纳入总生存的多变量分析。分析显示，年龄>70岁（p = 0.012）、骨转移数量>20（p = 0.018）、既往全身治疗（p = 0.018）和ALP水平>90 IU/L（p = 0.010）显著预测总生存较差。在有两个或更多这些因素的16例患者中，两年总生存率为36%，在有一个或没有这些因素的32例患者中为93%（p = 0.0004）。
年龄（>70岁）、骨肿瘤负荷增加（>20个转移灶和/或ALP水平升高）和/或既往全身治疗的CRPCa患者在接受西妥昔单抗治疗后更有可能迅速恶化。这些结果需要前瞻性验证。
