Buttigliero Consuelo, Tucci Marcello, Sonetto Cristina, Vignani Francesca, Di Stefano Rosario F, Pisano Chiara, Turco Fabio, Lacidogna Gaetano, Guglielmini Pamela, Numico Gianmauro, Scagliotti Giorgio V, Di Maio Massimo
Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
Minerva Urol Nefrol. 2020 Dec;72(6):737-745. doi: 10.23736/S0393-2249.20.03708-X. Epub 2020 Apr 10.
Previous studies demonstrated a predictive value of prostate-specific antigen (PSA) kinetics for treatment outcome. Our retrospective study evaluates the prognostic role of early PSA drop in metastatic castration resistant prostate cancer (mCRPC) patients receiving abiraterone acetate (AA) or enzalutamide (E).
All mCRPC patients treated with AA or E at the San Luigi Hospital in Orbassano between 2010 and 2018 and at the Ordine Mauriziano Hospital in Turin between 2014 and 2018 were included in this retrospective study. Only patients with an early PSA (measured 28-60 days after the beginning of the treatment) were included in the analysis. Patients were divided in early responders and non-early responders according to early PSA response (drop≥50% from baseline). Univariate and multivariate analyses for progression free survival (PFS) and overall survival (OS) were performed.
Of 144 patients with early PSA value, 61 (42.4%) patients received E (docetaxel-naïve 42, post-docetaxel 19) and 83 (57.6%) received AA (docetaxel-naïve 44, post-docetaxel 39). Seventy-five (52.1%) patients achieved early PSA drop. In docetaxel-naïve setting (N.=86), median PFS was 14.9 (with early PSA drop) vs. 8.8 months (without early PSA drop, P=0.001). In post-docetaxel setting (N.=58) median PFS was 11.9 vs. 4.5 months (P<0.001). Globally, median PFS was 14.9 vs. 6.3 months in patients with and without early PSA drop, respectively (P<0.001). In docetaxel-naïve setting, patients with early PSA drop had a median OS of 39.5 vs. 18.8 months (P=0.12). In post-docetaxel setting median OS was 29.6 vs. 10.7 months (P=0.01). Comprehensively, median OS was 31.9 vs. 16.3 (P=0.002) in patients with and without early PSA drop, respectively. At multivariate analysis, early PSA drop confirmed an independent association with PFS (HR 0.21; 95% CI: 0.12-0.38, P<0.001) and OS (HR 0.25; 95% CI: 0.12-0.50, P<0.001).
mCRPC patients treated with AA or E, in docetaxel-naïve or post-docetaxel setting, with early PSA drop had significantly better OS and PFS.
既往研究表明前列腺特异性抗原（PSA）动力学对治疗结果具有预测价值。我们的回顾性研究评估了早期PSA下降在接受醋酸阿比特龙（AA）或恩杂鲁胺（E）治疗的转移性去势抵抗性前列腺癌（mCRPC）患者中的预后作用。
本回顾性研究纳入了2010年至2018年在奥尔巴萨诺的圣路易吉医院以及2014年至2018年在都灵的毛里齐亚诺医院接受AA或E治疗的所有mCRPC患者。仅纳入治疗开始后28 - 60天测量早期PSA的患者进行分析。根据早期PSA反应（较基线下降≥50%）将患者分为早期反应者和非早期反应者。对无进展生存期（PFS）和总生存期（OS）进行单因素和多因素分析。
在144例有早期PSA值的患者中，61例（42.4%）患者接受E（初治多西他赛的42例，多西他赛治疗后的19例），83例（57.6%）接受AA（初治多西他赛的44例，多西他赛治疗后的39例）。75例（52.1%）患者实现了早期PSA下降。在初治多西他赛组（n = 86），有早期PSA下降者的中位PFS为14.9个月，无早期PSA下降者为8.8个月（P = 0.001）。在多西他赛治疗后组（n = 58），中位PFS分别为11.9个月和4.5个月（P < 0.001）。总体而言，有和无早期PSA下降的患者中位PFS分别为14.9个月和6.3个月（P < 0.001）。在初治多西他赛组，有早期PSA下降的患者中位OS为39.5个月对18.8个月（P = 0.12）。在多西他赛治疗后组，中位OS分别为29.6个月和10.7个月（P = 0.01）。综合来看，有和无早期PSA下降的患者中位OS分别为31.9个月和16.3个月（P = 0.002）。多因素分析时，早期PSA下降证实与PFS（风险比0.21；95%置信区间：0.12 - 0.38，P < 0.001）和OS（风险比0.25；95%置信区间：0.12 - 0.50，P < 0.001）独立相关。
在初治多西他赛或多西他赛治疗后的情况下，接受AA或E治疗且早期PSA下降的mCRPC患者的OS和PFS显著更好。
