Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guanghzou, People's Republic of China.
Radiat Oncol. 2021 Jan 6;16(1):5. doi: 10.1186/s13014-020-01732-y.
To investigate the potential benefit of cytoreductive radiotherapy (cRT) in metastatic castration-resistant prostate cancer (mCRPC) patients receiving abiraterone.
From February 2014 to February 2019, 149 mCRPC patients treated with abiraterone were identified. Patients receiving cRT before abiraterone failure (AbiRT group) were matched by one-to-two propensity score to patients without cRT before abiraterone failure (non-AbiRT group).
The median follow-up was 23.5 months. Thirty patients (20.1%) were in the AbiRT group, whereas 119 patients (79.9%) were in the non-AbiRT group. The 2-year OS of patients managed by AbiRT and non-AbiRT were 89.5% and 73.5%, respectively (P = 0.0003). On multivariate analysis, only AbiRT (HR 0.17; 95% CI 0.05-0.58; P = 0.004) and prognostic index (HR 2.71; 95% CI 1.37-5.35; P = 0.004) were significant factors. After matching, AbiRT continued to be associated with improved OS (median OS not reached vs. 44.0 months, P = 0.009). Subgroup analysis revealed that patients aged ≤ 65 years (HR 0.09; 95% CI 0.01-0.65; P = 0.018), PSA ≤ 20 ng/mL (HR 0.29; 95% CI 0.09-0.99; P = 0.048), chemotherapy-naïve upon abiraterone treatment (HR 0.20; 95% CI 0.06-0.66; P = 0.008) and in intermediate prognosis groups by COU-AA-301 prognostic index (HR 0.13; 95% CI 0.03-0.57; P = 0.007) had improved OS with AbiRT.
cRT before resistance to abiraterone may improve survival in selected mCRPC patients: age ≤ 65 years old, chemotherapy-naïve, with a relatively low PSA level at the diagnosis of mCRPC and intermediate prognosis.
研究去势抵抗性前列腺癌（mCRPC）患者在接受阿比特龙治疗前接受细胞减积放疗（cRT）的潜在获益。
从 2014 年 2 月至 2019 年 2 月，共确定了 149 例接受阿比特龙治疗的 mCRPC 患者。通过 1:2 的倾向评分匹配，比较了在阿比特龙治疗失败前接受 cRT（AbiRT 组）的患者与在阿比特龙治疗失败前未接受 cRT（非 AbiRT 组）的患者。
中位随访时间为 23.5 个月。30 例（20.1%）患者在 AbiRT 组，119 例（79.9%）患者在非 AbiRT 组。接受 AbiRT 和非 AbiRT 治疗的患者 2 年 OS 分别为 89.5%和 73.5%（P=0.0003）。多因素分析显示，仅 AbiRT（HR 0.17；95%CI 0.05-0.58；P=0.004）和预后指数（HR 2.71；95%CI 1.37-5.35；P=0.004）是显著的影响因素。匹配后，AbiRT 仍与改善的 OS 相关（中位 OS 未达到 vs. 44.0 个月，P=0.009）。亚组分析显示，年龄≤65 岁（HR 0.09；95%CI 0.01-0.65；P=0.018）、PSA≤20ng/mL（HR 0.29；95%CI 0.09-0.99；P=0.048）、阿比特龙治疗时未接受化疗（HR 0.20；95%CI 0.06-0.66；P=0.008）和 COU-AA-301 预后指数中为中危组（HR 0.13；95%CI 0.03-0.57；P=0.007）的患者，接受 AbiRT 治疗后 OS 得到改善。
在选择的 mCRPC 患者中，在对阿比特龙产生耐药之前接受 cRT 可能会改善生存：年龄≤65 岁，化疗初治，mCRPC 诊断时 PSA 水平相对较低，以及预后为中危。
