联合雄激素阻断治疗的激素敏感型前列腺癌患者的预后因素：日本单中心连续 15 年研究。
Prognostic Factors in Hormone-sensitive Prostate Cancer Patients Treated With Combined Androgen Blockade: A Consecutive 15-year Study at a Single Japanese Institute.
机构信息
Department of Urology, Gunma University Graduate School of Medicine, Gunma, Japan
Department of Urology, Gunma University Graduate School of Medicine, Gunma, Japan.
出版信息
In Vivo. 2021 Jan-Feb;35(1):373-384. doi: 10.21873/invivo.12268.
BACKGROUND/AIM: There are several treatment options for metastatic hormone-sensitive prostate cancer (mHSPC) in the world. In recent years, the use of docetaxel, abiraterone, enzalutamide, and apalutamide has been used for mHSPC, but combined androgen blockade (CAB) therapy using first-generation antiandrogens has been widely used in Japan. There is a background. We performed a consecutive study of patients who received combined androgen blockade (CAB) at a single institute to determine the prognostic factors for mHSPC.
PATIENTS AND METHODS
We conducted a consecutive study of 237 mHSPC patients treated with CAB from 2003 to 2017 at the Gunma University Hospital. Prostate-specific antigen progression-free survival (PSA-PFS) and overall survival (OS) were estimated by the Kaplan-Meier method. The associations between pre-treatment risk factors and the PSA response 3 months after starting CAB, PSA-PFS, and OS were evaluated by the Cox proportional hazards model.
RESULTS
Among the 237 cases, the median PSA-PFS and OS times were 63.0 and 91.4 months, respectively. The median PSA-PFS and OS times of M1 cases (174 cases, 73.4% of all 237 cases) were 36.1 and 75.9 months, respectively. The Eastern Cooperative Oncology Group performance status (ECOG PS) score, hemoglobin (Hb), lactate dehydrogenase, extent of disease, visceral metastasis (no vs. yes), and PSA response after 3 months were significant predictors of OS according to Cox regression analysis of prognostic factors in M1 patients. The ECOG PS, Hb, visceral metastasis (no vs. yes), and PSA response after 3 months predicted OS high-risk patients in LATITUDE criteria. The OS was 92.1 months in the low-risk group (0-1 risk factors), 48.2 months in the intermediate-risk group (2 risk factors), and 16.9 months in the high-risk group (3-4 risk factors).
CONCLUSION
CAB should be considered as a treatment option for strictly selected patients with mHSPC, even though novel treatments are available.
背景/目的：在世界范围内，转移性激素敏感型前列腺癌（mHSPC）有多种治疗选择。近年来，多西他赛、阿比特龙、恩扎鲁胺和阿帕鲁胺已用于 mHSPC，但第一代抗雄激素的联合雄激素阻断（CAB）治疗在日本被广泛应用。有这样一个背景。我们对在单一机构接受联合雄激素阻断（CAB）治疗的 mHSPC 患者进行了连续研究，以确定 mHSPC 的预后因素。
患者和方法
我们对 2003 年至 2017 年在群马大学医院接受 CAB 治疗的 237 例 mHSPC 患者进行了连续研究。通过 Kaplan-Meier 法估计前列腺特异性抗原无进展生存期（PSA-PFS）和总生存期（OS）。通过 Cox 比例风险模型评估治疗前危险因素与 CAB 开始后 3 个月 PSA 反应、PSA-PFS 和 OS 的相关性。
结果
在 237 例患者中，中位 PSA-PFS 和 OS 时间分别为 63.0 和 91.4 个月。M1 病例（237 例，占所有病例的 73.4%）的中位 PSA-PFS 和 OS 时间分别为 36.1 和 75.9 个月。根据 Cox 回归分析 M1 患者的预后因素，东部合作肿瘤学组表现状态（ECOG PS）评分、血红蛋白（Hb）、乳酸脱氢酶、疾病程度、内脏转移（无 vs. 有）和 3 个月后的 PSA 反应是 OS 的显著预测因素。ECOG PS、Hb、内脏转移（无 vs. 有）和 3 个月后的 PSA 反应预测了 LATITUDE 标准中的 OS 高危患者。低危组（0-1 个危险因素）的 OS 为 92.1 个月，中危组（2 个危险因素）为 48.2 个月，高危组（3-4 个危险因素）为 16.9 个月。
结论
即使有新的治疗方法，CAB 也应被视为严格选择的 mHSPC 患者的治疗选择。
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