Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.
Urology Section, Veterans Affairs Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
Eur Urol Focus. 2017 Oct;3(4-5):480-486. doi: 10.1016/j.euf.2016.08.007. Epub 2016 Aug 29.
Although visceral metastases (VMs) are widely recognized to portend worse prognoses compared with bone and lymph metastases in men with metastatic castration-resistant prostate cancer (mCRPC), little is known about what predicts VMs and the extent to which men with VMs do worse.
To determine whether men with VMs at initial mCRPC diagnosis have worse overall survival (OS) and identify predictors of VMs.
DESIGN, SETTING, AND PARTICIPANTS: We analyzed 494 men diagnosed with castration-resistant prostate cancer post-1999 and no known metastases from five Veterans Affairs hospitals of the Shared Equal Access Regional Cancer Hospital (SEARCH) database who later developed metastases. Radiology scans within 30 d of initial metastasis diagnosis were reviewed to collect information on bone, visceral, and lymph node metastases. We analyzed the 236 men who had a computed tomography scan performed.
Predictors of VMs and OS were evaluated using logistic regression and Cox models, respectively.
Of the 236 mCRPC patients, 38 (16%) had VMs. Regarding VMs, 19 patients (50%), 8 patients (21%), and 16 patients (42%) had metastases in the liver, lungs, and other locations, respectively. VMs were a predictor of OS on crude analysis (hazard ratio [HR]: 1.88; 95% confidence interval [CI], 1.30-2.72; p=0.001) and after risk adjustment (HR: 1.84; 95% CI, 1.24-2.72; p=0.002). Age, year, treatment center, prostate-specific antigen (PSA), and time from CRPC to metastases were significant in predicting OS (all p<0.05). None of the variables tested were associated with having VMs (all p > 0.09). Prospective studies and larger cohorts are needed to validate our findings.
Demographic, tumor, and PSA kinetic characteristics were not predictive of having VMs, but VMs predicted worse OS.
Because patients with VMs have worse overall survival, further research is needed to develop better biomarkers and thus diagnose those with VMs at earlier stages in their disease course.
尽管内脏转移（VMs）被广泛认为比转移性去势抵抗性前列腺癌（mCRPC）患者的骨转移和淋巴结转移预后更差，但对于哪些因素预测 VMs 以及 VMs 患者的预后恶化程度，知之甚少。
确定初始 mCRPC 诊断时患有 VMs 的男性是否总生存期（OS）更差，并确定 VMs 的预测因素。
设计、地点和参与者：我们分析了来自 SEARCH 数据库的 5 家退伍军人事务部医院的 494 名在 1999 年后被诊断患有去势抵抗性前列腺癌且无已知转移的患者，他们后来出现了转移。在初始转移诊断后 30 天内进行的放射学扫描中收集了骨、内脏和淋巴结转移的信息。我们分析了进行了 CT 扫描的 236 名患者。
分别使用逻辑回归和 Cox 模型评估 VMs 和 OS 的预测因素。
在 236 名 mCRPC 患者中，38 名（16%）患有 VMs。在 VMs 方面，19 名患者（50%）、8 名患者（21%）和 16 名患者（42%）分别在肝脏、肺部和其他部位有转移。VMs 在粗分析（风险比 [HR]：1.88；95%置信区间 [CI]，1.30-2.72；p=0.001）和风险调整后（HR：1.84；95% CI，1.24-2.72；p=0.002）都是 OS 的预测因素。年龄、年份、治疗中心、前列腺特异性抗原（PSA）和从 CRPC 到转移的时间在预测 OS 方面均有显著意义（均 p<0.05）。测试的变量均与 VMs 无关（均 p>0.09）。需要前瞻性研究和更大的队列来验证我们的发现。
人口统计学、肿瘤和 PSA 动力学特征不能预测 VMs 的发生，但 VMs 预示着更差的 OS。
由于 VMs 患者的总生存期更差，因此需要进一步研究以开发更好的生物标志物，从而在疾病早期阶段诊断出 VMs 患者。
