Zhao Feng, Wang Jili, Chen Meiqin, Chen Danni, Ye Sunyi, Li Xinke, Chen Xin, Ren Guoping, Yan Senxiang
Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
Graduate School, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
Clin Transl Med. 2019 Nov 29;8(1):30. doi: 10.1186/s40169-019-0247-4.
Bone is a preferential site for prostate cancer (PCa) metastasis. However, sites of synchronous distant metastases in PCa patients with bone metastases at initial diagnosis and their impacts on prognosis are still unclear, limiting our ability to better stratify and treat the patients. In this study, we examined the sites of synchronous extra-skeletal metastases in de novo PCa patients with bone metastases and their associated prognoses.
In total, 16,643 de novo PCa patients with bone metastases from the SEER database were included. After stratification of metastatic sites (bone, lung, liver, and brain) and treatment modalities, overall survival (OS) and independent predictors of OS, were analyzed.
Lung was the most frequent site of synchronous metastases, followed by liver, while brain metastases were relatively uncommon. Patients with bone-only metastases showed the longest mean survival time (35.87 months, p < 0.001), followed by patients with bone and lung metastases (30.74 months, p < 0.001). Patients with bone and liver metastases had the shortest mean survival time (17.39 months, p < 0.001). Age > 70 years, unmarried status, high tumor grade, prostate-specific antigen (PSA) > 50 ng/ml, and Gleason score ≥ 8 were associated with poor OS (all p < 0.01). Asian or Pacific Islander ethnic background was associated with a favorable OS (all p < 0.01). Chemotherapy improved OS in patients without brain metastases (all p < 0.05). For patients with bone-only metastases, radical prostatectomy (RP) (HR, 0.339; 95% CI 0.231-0.495; p < 0.001), brachytherapy (BT) (HR, 0.567; 95% CI 0.388-0.829; p = 0.003), and chemotherapy (HR, 0.850; 95% CI 0.781-0.924; p < 0.001) were associated with prolonged OS.
Age, race, tumor grade, PSA, Gleason score, sites of synchronous extra-skeletal metastases, as well as treatment modalities affected OS in newly diagnosed PCa patients with bone metastases. Synchronous liver metastases were associated with poor OS. Chemotherapy improved OS in patients without brain metastases. RP and BT improved OS in patients with bone-only metastases. Further investigation is warranted to validate these findings.
骨骼是前列腺癌（PCa）转移的优先部位。然而，初诊时伴有骨转移的PCa患者同步远处转移的部位及其对预后的影响仍不清楚，这限制了我们更好地对患者进行分层和治疗的能力。在本研究中，我们检查了初发伴有骨转移的PCa患者同步骨外转移的部位及其相关预后。
总共纳入了监测、流行病学与最终结果（SEER）数据库中的16643例初发伴有骨转移的PCa患者。在对转移部位（骨、肺、肝和脑）和治疗方式进行分层后，分析了总生存期（OS）和OS的独立预测因素。
肺是最常见的同步转移部位，其次是肝，而脑转移相对少见。仅骨转移患者的平均生存时间最长（35.87个月，p<0.001），其次是骨和肺转移患者（30.74个月，p<0.001）。骨和肝转移患者的平均生存时间最短（17.39个月，p<0.001）。年龄>70岁、未婚状态、高肿瘤分级、前列腺特异性抗原（PSA）>50 ng/ml和Gleason评分≥8与OS较差相关（所有p<0.01）。亚洲或太平洋岛民种族背景与较好的OS相关（所有p<0.01）。化疗改善了无脑转移患者的OS（所有p<0.05）。对于仅骨转移患者，根治性前列腺切除术（RP）（风险比[HR]，0.339；95%置信区间[CI] 0.231-0.495；p<0.001）、近距离放射治疗（BT）（HR，0.567；95% CI 0.388-0.829；p=0.003）和化疗（HR，0.850；95% CI 0.781-0.924；p<0.001）与OS延长相关。
年龄、种族、肿瘤分级、PSA、Gleason评分、同步骨外转移部位以及治疗方式影响新诊断的伴有骨转移的PCa患者的OS。同步肝转移与OS较差相关。化疗改善了无脑转移患者的OS。RP和BT改善了仅骨转移患者的OS。有必要进行进一步研究以验证这些发现。
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