Department of Clinical Oncology, St James's Institute of Oncology, St James's University Hospital, Leeds, UK.
Departments of Clinical Oncology and Nuclear Medicine, Castle Hill Hospital, Cottingham, UK.
Clin Oncol (R Coll Radiol). 2018 Sep;30(9):548-555. doi: 10.1016/j.clon.2018.06.004. Epub 2018 Jun 19.
To analyse outcomes in metastatic castrate-resistant prostate cancer (mCRPC) patients treated with radium 223 (Ra-223) across the Yorkshire and Humber Cancer Network.
A regional, multicentre, retrospective cohort study of 189 men undergoing Ra-223 for mCRPC between March 2014 and April 2017 was undertaken. Factors predicting overall survival and completion of planned treatment were assessed.
The median overall survival for the entire cohort was 10.5 months. Those completing five to six cycles of Ra-223 had a higher overall survival of 18.6 months. On multivariable analysis, four factors remained independent significant predictors of overall survival: age (P = 0.005, hazard ratio 1.07 [1.02-1.12]); number of cycles of Ra-223: 5-6 versus 1-4 (P ≤ 0.001, hazard ratio 0.10 [0.005-0.20]); baseline alkaline phosphatase (P = 0.044, hazard ratio 1.06 [1.002-1.12]); neutrophil-to-lymphocyte ratio (P = 0.033, hazard ratio 1.19 [1.01-1.40]). Baseline performance status 0 versus 2 (P = 0.026, odds ratio 0.080 [0.001-0.74]) and higher baseline haemoglobin (P = 0.028, odds ratio 1.04 [1.004-1.074]) were independent predictors of the completion of five to six cycles of Ra-223.
Younger age, completion of five to six cycles of Ra-223, lower alkaline phosphatase and neutrophil-to-lymphocyte ratio are predictors of overall survival. This is the first study to report neutrophil-to-lymphocyte ratio as an independent predictor of overall survival in a Ra-223 cohort. Good performance status and higher baseline haemoglobin predict the completion of five to six cycles of Ra-223.
分析在约克郡和亨伯癌症网络中接受镭 223（Ra-223）治疗的转移性去势抵抗性前列腺癌（mCRPC）患者的结局。
进行了一项针对 189 名 mCRPC 患者的区域性、多中心、回顾性队列研究，这些患者于 2014 年 3 月至 2017 年 4 月期间接受 Ra-223 治疗。评估了预测总生存和完成计划治疗的因素。
整个队列的中位总生存期为 10.5 个月。完成 5-6 个周期 Ra-223 治疗的患者总生存期更高，为 18.6 个月。多变量分析显示，有四个因素仍然是总生存的独立显著预测因素：年龄（P=0.005，风险比 1.07[1.02-1.12]）；Ra-223 周期数：5-6 个周期与 1-4 个周期（P≤0.001，风险比 0.10[0.005-0.20]）；基线碱性磷酸酶（P=0.044，风险比 1.06[1.002-1.12]）；中性粒细胞与淋巴细胞比值（P=0.033，风险比 1.19[1.01-1.40]）。基线体能状态 0 与 2（P=0.026，优势比 0.080[0.001-0.74]）和较高的基线血红蛋白（P=0.028，优势比 1.04[1.004-1.074]）是完成 5-6 个 Ra-223 周期治疗的独立预测因素。
年龄较小、完成 5-6 个 Ra-223 周期、碱性磷酸酶和中性粒细胞与淋巴细胞比值较低是总生存的预测因素。这是第一项报告中性粒细胞与淋巴细胞比值为 Ra-223 队列中总生存的独立预测因素的研究。良好的体能状态和较高的基线血红蛋白预测了完成 5-6 个 Ra-223 周期的治疗。
