Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
Unit of Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy.
Clin Genitourin Cancer. 2020 Jun;18(3):185-191. doi: 10.1016/j.clgc.2019.10.009. Epub 2019 Oct 16.
We investigated, in a real-life setting, the prognostic relevance of previous primary treatment (radical prostatectomy [RP] or external beam radiotherapy [EBRT]) on overall survival for patients with metastatic castration-resistant prostate cancer (mCRPC) treated with radium-223 (Ra).
In the present multicenter retrospective study, we enrolled 275 consecutive patients. The demographic and clinical data and mCRPC characteristics were recorded and evaluated at baseline and at the end of treatment or progression. Ra was administered according to the current label authorization until disease progression or unacceptable toxicity. We divided the whole cohort into 2 groups: those who had undergone primary radical prostatectomy or ablative radiotherapy (RP/EBRT) and those who had not received previous primary treatment (NO).
Of the 275 patients, 128 (46.5%) were alive and undergoing monitoring at the last follow-up examination, 103 (37.4%) had stopped treatment because of disease progression or the onset of comorbidities, and 147 (53.5%) had died during the study period. Of the 275 patients, 132 were in the RP/EBRT group (48%), of whom 93 had undergone RP and 76 had undergone ablative EBRT, and 143 patients were in the NO group (52%). The data showed a clear advantage for the patients in the RP/EBRT group compared with those in the NO group, with an estimated median survival of 18 versus 11 months, respectively (P < .001). The results from the multivariate analysis corroborated this trend, with a hazard ratio of 0.7 (P = .0443), confirming the better outcome for the RP/EBRT group.
Previous radical treatment provides a protective role for patients with mCRPC undergoing Ra treatment.
我们在真实环境中研究了既往根治性前列腺切除术（RP）或外照射放疗（EBRT）对接受镭-223（Ra）治疗的转移性去势抵抗性前列腺癌（mCRPC）患者总生存期的预后相关性。
在这项多中心回顾性研究中，我们纳入了 275 例连续患者。记录并评估了基线时和治疗结束或进展时的人口统计学和临床数据以及 mCRPC 特征。根据当前标签授权，给予 Ra 治疗，直至疾病进展或出现不可接受的毒性。我们将整个队列分为 2 组：接受过根治性前列腺切除术或消融放疗（RP/EBRT）的患者和未接受过既往主要治疗（NO）的患者。
在 275 例患者中，128 例（46.5%）在最后一次随访检查时仍存活并接受监测，103 例（37.4%）因疾病进展或合并症发生而停止治疗，147 例（53.5%）在研究期间死亡。在 275 例患者中，132 例（48%）为 RP/EBRT 组，其中 93 例行 RP，76 例行消融 EBRT，143 例为 NO 组（52%）。数据显示，RP/EBRT 组患者明显优于 NO 组，中位估计生存期分别为 18 个月和 11 个月（P<.001）。多变量分析结果证实了这一趋势，风险比为 0.7（P=.0443），证实了 RP/EBRT 组的更好结局。
既往根治性治疗为接受 Ra 治疗的 mCRPC 患者提供了保护作用。
