Tamada Satoshi, Iguchi Taro, Kato Minoru, Asakawa Jumpei, Kita Kazuaki, Yasuda Sayaka, Yamasaki Takeshi, Matsuoka Yudai, Yamaguchi Kazuyuki, Matsumura Kentaro, Go Ishun, Ohmachi Tetsuji, Nakatani Tatsuya
Department of Urology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan.
Department of Urology, Bell Land General Hospital, Naka-ku, Sakai City, Osaka 599-8247, Japan.
Oncotarget. 2018 Dec 11;9(97):36966-36974. doi: 10.18632/oncotarget.26426.
The aim of our retrospective study was to determine the time to progression to castration-resistant prostate cancer (CRPC) in prostate cancer patients who undergo combined androgen blockade (CAB), as well as their prognoses.
We examined the overall survival (OS) and disease-specific survival rates, as well as the time to CRPC development, in 387 patients who were treated with CAB for prostate cancer. The disease-specific survival rate and time to CRPC were stratified by prostate-specific antigen (PSA) levels, Gleason score (GS), and presence of metastasis at diagnosis. We designated high-risk patients as those satisfying at least two of the following three criteria: extent of disease of bone metastasis grade ≥2, presence of metastasis at diagnosis, and a GS ≥8.
The 10- and 15-year OS rates were 74.0% and 50.4%, respectively, while the corresponding disease-specific survival rates were both 86.8%. Metastasis at diagnosis was an independent prognostic factor for disease-specific survival. The median time to CRPC development was 140.7 months. A PSA level ≥20 ng/mL, a GS ≥8, and the presence of metastasis at diagnosis were independent predictors of a shorter time to CRPC development. The 10-year disease-specific survival rate in the high-risk group was significantly lower than that in the low-risk group (approximately 74% vs. 98%), and the time to CRPC development was significantly shorter (median: 20.5 months vs. not reached).
The time to CRPC development was shorter in high-risk prostate cancer patients with metastases. Such patients require alternative novel treatment modalities.
我们这项回顾性研究的目的是确定接受联合雄激素阻断（CAB）治疗的前列腺癌患者进展为去势抵抗性前列腺癌（CRPC）的时间及其预后情况。
我们研究了387例接受CAB治疗的前列腺癌患者的总生存率（OS）和疾病特异性生存率，以及进展为CRPC的时间。疾病特异性生存率和进展为CRPC的时间根据前列腺特异性抗原（PSA）水平、 Gleason评分（GS）以及诊断时是否存在转移进行分层。我们将满足以下三项标准中至少两项的患者定义为高危患者：骨转移程度≥2级、诊断时存在转移以及GS≥8。
10年和15年的总生存率分别为74.0%和50.4%，而相应的疾病特异性生存率均为86.8%。诊断时存在转移是疾病特异性生存的独立预后因素。进展为CRPC的中位时间为140.7个月。PSA水平≥20 ng/mL、GS≥8以及诊断时存在转移是进展为CRPC时间较短的独立预测因素。高危组的10年疾病特异性生存率显著低于低危组（约74%对98%），进展为CRPC的时间显著更短（中位时间：20.5个月对未达到）。
有转移的高危前列腺癌患者进展为CRPC的时间较短。这类患者需要替代性的新型治疗模式。
