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OBJECTIVE

To determine prognostic factors including the Bone Scan Index in prostate cancer patients receiving standard hormonal therapy and chemotherapy.

METHODS

This multicenter Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index study involved 30 hospitals and enrolled 247 patients (age 71 ± 8 years) with metastatic hormone-sensitive prostate cancer (n = 148) under hormone therapy and metastatic castration-resistant prostate cancer (n = 99) under chemotherapy. The Bone Scan Index (%) was determined by whole-body bone scintigraphy using Tc-methylenediphosphonate. Patients were classified into tertiles and binary groups, and predictors of all-cause death including Bone Scan Index, prostate-specific antigen, and bone metabolic markers were determined using survival and proportional hazard analyses.

RESULTS

During a mean follow-up period of 716 ± 404 days, 81 (33%) of the patients died, and 3-year mortality rates were 20% and 52% in the metastatic hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer groups, respectively. Survival analysis showed that a Bone Scan Index >3.5% was a significant determinant of death in the metastatic hormone-sensitive prostate cancer group, whereas prostate-specific antigen >55 ng/mL before chemotherapy was a determinant of prognosis in the metastatic castration-resistant prostate cancer group. A Bone Scan Index >3.5% was also associated with a high incidence of prostate-specific antigen progression in the metastatic hormone-sensitive prostate cancer group. Patients with metastatic hormone-sensitive prostate cancer and a better Bone Scan Index response (>45%) to treatment had lower mortality rates than those without such response.

CONCLUSION

The Bone Scan Index and hot spot number are significant determinants of 3-year mortality, and combining the Bone Scan Index with prostate-specific antigen should contribute to the management of prostate cancer patients with bone metastasis.

目的

确定接受标准激素治疗和化疗的前列腺癌患者的预后因素，包括骨扫描指数。

方法

这项多中心前列腺癌标准激素和化疗应用骨扫描指数研究涉及 30 家医院，共纳入 247 例转移性激素敏感前列腺癌（n=148 例，接受激素治疗）和转移性去势抵抗性前列腺癌（n=99 例，接受化疗）患者。通过 Tc-亚甲基二膦酸盐全身骨闪烁照相术确定骨扫描指数（%）。患者分为三分位和二进制组，使用生存和比例风险分析确定包括骨扫描指数、前列腺特异性抗原和骨代谢标志物在内的全因死亡预测因子。

结果

在平均 716±404 天的随访期间，81 例（33%）患者死亡，转移性激素敏感前列腺癌和转移性去势抵抗性前列腺癌组的 3 年死亡率分别为 20%和 52%。生存分析显示，在转移性激素敏感前列腺癌组中，骨扫描指数>3.5%是死亡的显著决定因素，而在转移性去势抵抗性前列腺癌组中，化疗前前列腺特异性抗原>55ng/mL 是预后的决定因素。骨扫描指数>3.5%也与转移性激素敏感前列腺癌组中前列腺特异性抗原进展的发生率较高相关。接受治疗后骨扫描指数反应（>45%）较好的转移性激素敏感前列腺癌患者的死亡率较低。