Honecker Friedemann, Wedding Ulrich, Kallischnigg Gerd, Schroeder Axel, Klier Jörg, Frangenheim Thomas, Weißbach Lothar
Tumor and Breast Center ZeTuP St Gallen, Rorschacher Str 150, 9006, St Gallen, Switzerland.
Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany.
J Cancer Res Clin Oncol. 2018 Mar;144(3):571-577. doi: 10.1007/s00432-017-2577-1. Epub 2018 Jan 4.
To gain knowledge about the factors associated with discontinuation of scheduled treatment in elderly men with castration-resistant prostate cancer (CRPC).
Patients ≥ 70 years with CRPC starting a new line of treatment were included in a prospective cohort study. A geriatric assessment (CGA) was performed at baseline, including comorbidity, mobility, functional/mental/nutritional status, as well as depression. Furthermore, pain intensity, quality of life, ECOG-performance status, and physicians' and patients' perception of health were documented. Reasons for and factors associated with discontinuation of scheduled treatment were analysed by univariate and multivariate analysis.
After inclusion of 177 of 300 planned patients, the study was closed due to slow recruitment. 160 patients were eligible for final analysis. Median age was 77.5 years. 46% received chemotherapy, and 54% hormonal treatment. Discontinuation of scheduled treatment occurred in 91 patients (57.6%). The main reasons were progressive disease/death in 63%, adverse events/toxicity in 22%, and withdrawal of consent in 8%. In bivariate analyses, factors associated with discontinuation of treatment were age ≥ 80 years, ECOG PS ≥ 2, compromised/poor health status (physicians'/patients' assessment), and compromised functional or nutritional status. In multivariate analysis, the only remaining factor independently associated with discontinuation of scheduled treatment was impairment of activities of daily living (ADL < 100 points) (OR = 4.2 for discontinuation; p < 0.05).
Despite limitations due to early termination of the study, our results demonstrate that discontinuation of scheduled treatment was common, and that compromised ADL seems to be a significant risk factor for treatment failure in elderly patients with CRPC.
了解去势抵抗性前列腺癌（CRPC）老年男性患者计划治疗中断的相关因素。
≥70岁开始新一线治疗的CRPC患者纳入前瞻性队列研究。基线时进行老年综合评估（CGA），包括合并症、活动能力、功能/心理/营养状况以及抑郁情况。此外，记录疼痛强度、生活质量、东部肿瘤协作组（ECOG）体能状态以及医生和患者对健康的认知。通过单因素和多因素分析来分析计划治疗中断的原因及相关因素。
在计划纳入的300例患者中纳入177例后，由于招募缓慢研究结束。160例患者符合最终分析条件。中位年龄为77.5岁。46%接受化疗，54%接受激素治疗。91例患者（57.6%）出现计划治疗中断。主要原因是疾病进展/死亡占63%，不良事件/毒性反应占22%，撤回同意占8%。在双因素分析中，与治疗中断相关的因素有年龄≥80岁、ECOG体能状态≥2、健康状况受损/差（医生/患者评估）以及功能或营养状况受损。在多因素分析中，与计划治疗中断独立相关的唯一剩余因素是日常生活活动能力受损（ADL＜100分）（治疗中断的比值比=4.2；p＜0.05）。
尽管因研究提前终止存在局限性，但我们的结果表明计划治疗中断很常见，且日常生活活动能力受损似乎是老年CRPC患者治疗失败的一个重要危险因素。
