PSA 时间至最低点作为一线多西他赛治疗去势抵抗性前列腺癌的预后因素：来自中国前列腺癌联盟患者的多中心验证。

PSA time to nadir as a prognostic factor of first-line docetaxel treatment in castration-resistant prostate cancer: Multicenter validation in patients from the Chinese Prostate Cancer Consortium.

机构信息

Key Laboratory for Tumor Precision Medicine of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China.

Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, PR China.

出版信息

Urol Oncol. 2020 Jan;38(1):2.e11-2.e17. doi: 10.1016/j.urolonc.2019.07.014. Epub 2019 Oct 28.

DOI:10.1016/j.urolonc.2019.07.014

PMID:31672485

Abstract

OBJECTIVE

Docetaxel-based chemotherapy remains the first-line treatment for patients with metastatic castration-resistant prostate cancer (mCRPC) in China. We have previously shown that time to nadir (TTN) of prostate-specific antigen (PSA) is an important prognostic factor in patients from a single center in Northwestern China. In this study, we performed a multicenter validation of the prognostic role of TTN in additional Chinese patients with mCRPC receiving docetaxel treatment.

MATERIALS AND METHODS

The data were gathered from 170 eligible Chinese patients who received docetaxel chemotherapy from January 2007 to October 2018 in 11 Chinese Prostate Cancer Consortium member hospitals in China. TTN was defined as the time from start of chemotherapy to the nadir of PSA level during the treatment. Multivariable Cox regression models and Kaplan-Meier analysis were used to predict overall survival (OS) and progression-free survival (PFS).

RESULTS

Patients with a TTN ≥ 15 weeks had a longer OS and PFS compared to those with a TTN < 15 weeks (43 vs. 15 months, P < 0.001; 24 vs. 6 months, P < 0.001, respectively). In addition, Patients with a TTN ≥ 15 weeks and PSA nadir <4.55ng/ml were associated with longer OS than others (HR 0.093, 95% CI 0.044-0.188, P < 0.001; HR 4.002, 95% CI 1.890-8.856, P = 0.001, respectively) and TTN, PSA nadir, PSA baseline (optimal threshold 56.07 ng/ml), and PSA reduction (optimal threshold 50%) were associated with PFS (HR 0.238, 95% CI 0.149-0.382, P < 0.001; HR 1.676, 95% CI 1.033-2.722, P = 0.037; HR 1.770, 95% CI 1.134-2.763, P = 0.012; HR 0.573, 95% CI 0.428-0.756, P < 0.001; respectively). Furthermore, patients with a PSA nadir <4.55 ng/ml had longer OS and PFS compared to other patients when TTN was ≥15 weeks.

CONCLUSION

In this multicenter validation study, TTN and PSA nadir remain important prognostic markers in predicting therapeutic outcomes in Chinese men who receive chemotherapy for mCRPC.

摘要

目的

多西他赛为基础的化疗仍是中国转移性去势抵抗性前列腺癌（mCRPC）患者的一线治疗方法。我们之前的研究表明，前列腺特异性抗原（PSA）的至最低点时间（TTN）是中国西北地区单个中心患者的重要预后因素。在这项研究中，我们在接受多西他赛治疗的另外 170 名中国 mCRPC 患者中进行了 TTN 预后作用的多中心验证。

材料与方法

从 2007 年 1 月至 2018 年 10 月，11 家中国前列腺癌联盟成员医院的 170 名符合条件的中国患者中收集了数据。TTN 定义为化疗开始至治疗期间 PSA 水平最低点的时间。多变量 Cox 回归模型和 Kaplan-Meier 分析用于预测总生存期（OS）和无进展生存期（PFS）。

结果

TTN≥15 周的患者 OS 和 PFS 均长于 TTN＜15 周的患者（43 个月 vs. 15 个月，P＜0.001；24 个月 vs. 6 个月，P＜0.001）。此外，TTN≥15 周且 PSA 最低点＜4.55ng/ml 的患者 OS 长于其他患者（HR 0.093，95%CI 0.044-0.188，P＜0.001；HR 4.002，95%CI 1.890-8.856，P=0.001）。TTN、PSA 最低点、PSA 基线（最佳阈值 56.07ng/ml）和 PSA 降低（最佳阈值 50%）与 PFS 相关（HR 0.238，95%CI 0.149-0.382，P＜0.001；HR 1.676，95%CI 1.033-2.722，P=0.037；HR 1.770，95%CI 1.134-2.763，P=0.012；HR 0.573，95%CI 0.428-0.756，P＜0.001）。此外，当 TTN≥15 周时，PSA 最低点＜4.55ng/ml 的患者 OS 和 PFS 均长于其他患者。