Tian Shengri, Lei Zhen, Gong Zuo, Sun Zhonghai, Xu Dongyuan, Piao Minhu
Department of Urology, Yanbian University Hospital, Yanji, Jilin China.
Cancer Cell Int. 2020 Aug 26;20:409. doi: 10.1186/s12935-020-01508-0. eCollection 2020.
Diagnosis of metastatic castrate resistant prostate cancer (mCRPC) with current biomarkers is difficult and often results in unnecessary invasive procedures as well as over-diagnosis and over-treatment. There are a number of prognostic biomarkers for CRPC, but there are no validated predictive biomarkers to guide in clinical decision-making. Specific biomarkers are needed that enable to understand the natural history and complex biology of this heterogeneous malignancy, identify early response to treatment outcomes and to identify the population of men most likely to benefit from the treatment. In this systematic review, we discuss the existing literature for the role of biomarkers in CRPC and how they aid in the prognosis, treatment selection and survival outcomes.
We performed a literature search on PubMed and EMBASE databases from January 2015 through February 2020 in accordance to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Articles were assessed to identify relevant observational studies and randomized controlled trials regarding biomarkers which aid in identifying progression to mCRPC as well as predictive biomarkers which help in treatment selection.
We identified 3640 number of hits of which 58 articles were found to be relevant. Here we addressed biomarkers in the context of prognosis, prediction and patient selection of therapy. These biomarkers were found to be effective as prognostic or predictive factors under variety of conditions. The higher levels for all these biomarkers were associated with shorter median OS and sometimes PFS. Lower amounts of biomarkers in serum or urine were associated with prolonged survival outcomes, longer time to CRPC development or CRPC progression and longer median follow-up irrespective of any therapy.
We observed that the biomarkers included in our study predicted clinically relevant survival outcomes and treatment exposure. Though the current biomarkers are prognostic when measured prior to initiating treatment, not all are validated as predictive markers in post treatment setting. A greater understanding of biomarkers in CRPC is need of the hour for development of more personalized approach to maximize benefit and minimize harm in men with CRPC.
利用当前的生物标志物诊断转移性去势抵抗性前列腺癌（mCRPC）存在困难，常常导致不必要的侵入性检查以及过度诊断和过度治疗。对于CRPC有多种预后生物标志物，但尚无经过验证的预测性生物标志物来指导临床决策。需要特定的生物标志物来帮助理解这种异质性恶性肿瘤的自然病程和复杂生物学特性，识别对治疗结果的早期反应，并确定最可能从治疗中获益的男性群体。在本系统评价中，我们讨论了生物标志物在CRPC中的作用的现有文献，以及它们如何有助于预后、治疗选择和生存结果。
我们按照系统评价和Meta分析的首选报告项目指南，于2015年1月至2020年2月在PubMed和EMBASE数据库中进行了文献检索。对文章进行评估，以确定有关有助于识别进展为mCRPC的生物标志物以及有助于治疗选择的预测性生物标志物的相关观察性研究和随机对照试验。
我们共检索到3640条结果，其中58篇文章被认为相关。在此，我们在预后、预测和治疗患者选择的背景下讨论了生物标志物。这些生物标志物在各种情况下均被发现可作为有效的预后或预测因素。所有这些生物标志物水平较高均与较短的中位总生存期相关，有时也与较短的无进展生存期相关。血清或尿液中生物标志物含量较低与延长的生存结果、较长的CRPC发生时间或CRPC进展时间以及较长的中位随访时间相关，无论接受何种治疗。
我们观察到，我们研究中纳入的生物标志物可预测临床相关的生存结果和治疗暴露情况。尽管当前的生物标志物在开始治疗前测量时具有预后价值，但并非所有生物标志物在治疗后环境中都被验证为预测标志物。当前迫切需要更深入地了解CRPC中的生物标志物，以制定更个性化的方法，使CRPC男性患者的获益最大化并将危害最小化。
