Suzuki Kotaro, Okamura Yasuyoshi, Hara Takuto, Terakawa Tomoaki, Furukawa Junya, Harada Kenichi, Hinata Nobuyuki, Fujisawa Masato
Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Int J Clin Oncol. 2021 Aug;26(8):1533-1540. doi: 10.1007/s10147-021-01931-x. Epub 2021 May 28.
Although bone metastasis beyond the vertebrae and pelvis has been a key factor in prognostic models of metastatic hormone-sensitive prostate cancer (mHSPC), the clinical significance of it is still unclear. The present study evaluated the prognostic impact of the volume of bone metastasis beyond the vertebrae and pelvis on the outcomes of mHSPC and created an ideal risk classification based on it.
We retrospectively reviewed 197 patients with mHSPC who were treated with combined androgen blockade as the initial treatment between June 2003 and October 2019. We calculated the bone scan index (BSI), including the BSI beyond the vertebrae and pelvis (bBSI), using BONENAVI, and investigated the association between the BSI and the overall survival (OS) of mHSPC.
According to the CHAARTED criteria, 91 and 106 patients were classified into the low- and high-volume groups, respectively. Of the 79 patients who did not have visceral metastasis in the high-volume group, those with a bBSI ≤ 0.27 (n = 16) showed a favorable OS, as did those in the low-volume group. The modified CHAARTED high-volume group (presence of visceral metastases or 4 bone lesions with a bBSI > 0.27) showed a significantly shorter OS than others, with a hazard ratio (HR) of 4.69 (p < 0.001), which was higher than that observed with the original CHAARTED criteria (HR = 4.33).
Our data suggested that considering the volume of bone metastasis beyond the vertebrae and pelvis may help to improve the accuracy of risk classification. Further large-scale prospective studies are needed to validate our findings.
尽管椎骨和骨盆以外的骨转移一直是转移性激素敏感性前列腺癌（mHSPC）预后模型的关键因素，但其临床意义仍不明确。本研究评估了椎骨和骨盆以外骨转移体积对mHSPC预后的影响，并基于此创建了理想的风险分类。
我们回顾性分析了2003年6月至2019年10月期间接受联合雄激素阻断作为初始治疗的197例mHSPC患者。我们使用BONENAVI计算骨扫描指数（BSI），包括椎骨和骨盆以外的BSI（bBSI），并研究BSI与mHSPC总生存期（OS）之间的关联。
根据CHAARTED标准，91例和106例患者分别被分为低转移体积组和高转移体积组。在高转移体积组中没有内脏转移的79例患者中，bBSI≤0.27的患者（n = 16）与低转移体积组患者一样，OS良好。改良的CHAARTED高转移体积组（存在内脏转移或4处骨转移且bBSI>0.27）的OS明显短于其他组，风险比（HR）为4.69（p<0.001），高于原始CHAARTED标准观察到的HR（HR = 4.33）。
我们的数据表明，考虑椎骨和骨盆以外的骨转移体积可能有助于提高风险分类的准确性。需要进一步的大规模前瞻性研究来验证我们的发现。
