Mori Keiichiro, Kimura Takahiro, Ito Kagenori, Onuma Hajime, Tanaka Masatoshi, Matsuura Taishi, Kurokawa Gaku, Iwatani Kosuke, Inaba Yuzo, Sakanaka Keigo, Sasaki Hiroshi, Miki Jun, Shimomura Tatsuya, Miki Kenta, Egawa Shin
Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
Prostate. 2018 Jul;78(10):766-772. doi: 10.1002/pros.23534. Epub 2018 Apr 10.
To evaluate the role of androgen receptor-axis-targeted drugs (ARAT) in non-metastatic castration-resistant prostate cancer (nmCRPC) versus mCRPC.
Chemotherapy-naive patients (n = 114) with CRPC who had no metastasis at the time of diagnosis were included in this retrospective study. All patients were treated with ARAT at Jikei University and its affiliated hospitals from July 2014 to March 2017. The patients were stratified into nmCRPC (n = 81) and mCRPC (n = 33) groups according to their metastatic status at ARAT induction. The primary outcome measure was difference in overall survival (OS) between groups from the time of CRPC diagnosis. The patients were compared for progression-free survival (PFS) and prostate-specific antigen (PSA) response. The predictors of OS were explored by a multivariate Cox model.
The baseline demographics did not differ significantly between the groups. The median observation period from the diagnosis of CRPC was 24.5 months (range: 3-135) and 20 months (range: 1-66) in nmCRPC and mCRPC groups, respectively. The nmCRPC group demonstrated better OS from the time of diagnosis of CRPC in Kaplan-Meier analysis than mCRPC group (86 months vs 40 months; P = 0.004), with similar results obtained for PFS (P = 0.048) and PSA response (P = 0.0014). Multivariate analysis demonstrated non-metastatic status, low PSA, and long PSA doubling time (PSADT) at ARAT induction as the significant predictors of longer OS (P = 0.044, 0.0001, and 0.026, respectively).
Early use of ARAT may improve OS, PFS, and PSA response in CRPC. Larger, prospective studies will be required to confirm our findings.
评估雄激素受体轴靶向药物（ARAT）在非转移性去势抵抗性前列腺癌（nmCRPC）与转移性去势抵抗性前列腺癌（mCRPC）中的作用。
本回顾性研究纳入了114例初治的CRPC患者，这些患者在诊断时无转移。2014年7月至2017年3月期间，所有患者在东京慈惠会医科大学及其附属医院接受ARAT治疗。根据ARAT诱导时的转移状态，将患者分为nmCRPC组（n = 81）和mCRPC组（n = 33）。主要结局指标是从CRPC诊断时起两组患者总生存期（OS）的差异。比较患者的无进展生存期（PFS）和前列腺特异性抗原（PSA）反应。通过多变量Cox模型探索OS的预测因素。
两组患者的基线人口统计学特征无显著差异。nmCRPC组和mCRPC组从CRPC诊断开始的中位观察期分别为24.5个月（范围：3 - 135个月）和20个月（范围：1 - 66个月）。在Kaplan-Meier分析中，nmCRPC组从CRPC诊断时起的OS优于mCRPC组（86个月对40个月；P = 0.004），PFS（P = 0.048）和PSA反应（P = 0.0014）也得到类似结果。多变量分析显示，ARAT诱导时的非转移状态、低PSA水平和较长的PSA倍增时间（PSADT）是OS较长的显著预测因素（分别为P = 0.044、0.0001和0.026）。
早期使用ARAT可能改善CRPC患者的OS、PFS和PSA反应。需要更大规模的前瞻性研究来证实我们的发现。
