Tsuzuki Shunsuke, Kawano Shota, Fukuokaya Wataru, Mori Keiichiro, Nishikawa Hideomi, Tashiro Kojiro, Watanabe Daisuke, Uchimoto Taizo, Nishimura Kazuki, Yano Yusuke, Murakami Masaya, Koike Yusuke, Hata Kenichi, Koide Haruhisa, Miki Jun, Abe Hirokazu, Yamada Hiroki, Naruoka Takehito, Sugaya Shingo, Kimura Takahiro, Tomita Masayuki, Nakajo Hiroshi, Egawa Shin
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Urology, Kameda Medical Center, Chiba, Japan.
Jpn J Clin Oncol. 2021 Nov 1;51(11):1665-1671. doi: 10.1093/jjco/hyab115.
Randomized trials showed the survival benefits of the combined use of androgen receptor axis-targeted agents with androgen deprivation therapy in metastatic hormone-sensitive prostate cancer (mHSPC), regardless of the risk. However, treating patients with low-risk mHSPC with such intensive treatment is still debatable.
This retrospective study included 155 low-risk patients among 467 mHSPC patients treated in our affiliated institutions. The association between predictive factors and treatment outcomes was estimated using the Kaplan-Meier method and log-rank test. Predictive factors for castration resistant prostate cancer (CRPC)-free survival were investigated using Cox regression analyses.
During the median follow-up of 39 months, 38.7% of patients developed CRPC and 14.2% died. In the multivariate analyses, a presence of Gleason pattern 5 (hazard ratio [HR] 2.04), high alkaline phosphatase (HR 1.007) and high lactate dehydrogenase (HR 1.009) were significant predictive factors for shorter CRPC-free survival. Finally, 155 patients were stratified into favorable- and unfavorable-risk groups based on the numbers of the predictive factors. The overall survival (OS) in the unfavorable-risk group (total scores: 2-3) was significantly worse than that of the favorable-risk group (total score: 0-1) (P = 0.02). This prognostic model was assessed with 50 low-risk mHSPC patients from the external validation dataset and found both the time to CRPC, and the OS in the unfavorable-risk group was significantly worse than that of the favorable-risk group (P < 0.01).
The combination of Gleason pattern 5, high alkaline phosphatase and lactate dehydrogenase can predict those with worse OS in low-risk mHSPC patients.
随机试验表明，无论风险如何，在转移性激素敏感性前列腺癌（mHSPC）中联合使用雄激素受体轴靶向药物与雄激素剥夺疗法可带来生存获益。然而，对于低风险mHSPC患者采用如此强化的治疗仍存在争议。
这项回顾性研究纳入了在我们附属医院接受治疗的467例mHSPC患者中的155例低风险患者。使用Kaplan-Meier方法和对数秩检验评估预测因素与治疗结果之间的关联。使用Cox回归分析研究去势抵抗性前列腺癌（CRPC）无进展生存期的预测因素。
在39个月的中位随访期内，38.7%的患者发生了CRPC，14.2%的患者死亡。在多变量分析中，Gleason 5级（风险比[HR] 2.04）、高碱性磷酸酶（HR 1.007）和高乳酸脱氢酶（HR 1.009）是CRPC无进展生存期较短的显著预测因素。最后，根据预测因素的数量将155例患者分为低风险和高风险组。高风险组（总分：2-3）的总生存期（OS）显著低于低风险组（总分：0-1）（P = 0.02）。使用来自外部验证数据集的50例低风险mHSPC患者对该预后模型进行评估，发现高风险组的CRPC发生时间和OS均显著差于低风险组（P < 0.01）。
Gleason 5级、高碱性磷酸酶和乳酸脱氢酶的联合可预测低风险mHSPC患者中总生存期较差的患者。
