Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Veterans Affairs Health Care System, Durham, North Carolina, USA.
Cancer Med. 2021 Dec;10(23):8570-8580. doi: 10.1002/cam4.4372. Epub 2021 Nov 2.
Limited real-world data exist on treatment patterns and outcomes in patients with metastatic castration-sensitive prostate cancer (mCSPC).
A retrospective cohort study was conducted, using the Veterans Health Administration claims database (April 2013-March 2018). Among 369,734 prostate cancer patients, we selected all men who developed metastases within 90 days before or after medical/surgical castration and who received androgen deprivation therapy (ADT). Patients were categorized into four cohorts: ADT-only (± <90-day nonsteroidal anti-androgen [NSAA] use), ADT + NSAA, ADT + docetaxel, and ADT + abiraterone. Main outcomes were treatment patterns, time-to-progression to metastatic castration-resistant disease, and overall survival. Multivariable analysis and sensitivity analysis were conducted.
Of 1395 patients, 874 (63%) received ADT-only, 338 (24%) received ADT + NSAA, 108 (8%) received ADT + docetaxel, and 75 (5%) received ADT + abiraterone. Proportions on ADT-only and ADT + NSAA declined (from 66% to 60% and from 31% to 17%, respectively) over the study period, while proportions prescribed ADT + docetaxel or abiraterone increased from 3% to 9% and from 1% to 15%, respectively. Patients treated with ADT + NSAA had similar risks of castration-resistant disease (hazard ratio [HR] 1.05; 95% confidence interval [CI]: 0.87, 1.26) and overall mortality (HR 1.22; 95% CI: 0.97, 1.54) as ADT-only.
Most patients with mCSPC initiating ADT received ADT-only or ADT + NSAA, despite the emergence of docetaxel and novel hormonal therapies. Even in the most recent period (2017 to early 2018), only 24% of men received intensified therapy with agents known to prolong survival versus ADT-only. These data in real-world clinical practice suggest substantial room for improved outcomes in patients with mCSPC.
转移性去势敏感前列腺癌（mCSPC）患者的治疗模式和结局的真实世界数据有限。
本研究使用退伍军人健康管理局（Veterans Health Administration）索赔数据库（2013 年 4 月至 2018 年 3 月）进行了回顾性队列研究。在 369734 例前列腺癌患者中，我们选择了所有在去势治疗前或后 90 天内发生转移且接受雄激素剥夺治疗（ADT）的男性。患者分为四组：ADT 单药（±<90 天非甾体类抗雄激素[NSAA]治疗）、ADT+NSAA、ADT+多西他赛和 ADT+阿比特龙。主要结局为治疗模式、进展为转移性去势抵抗性疾病的时间和总生存时间。进行了多变量分析和敏感性分析。
在 1395 例患者中，874 例（63%）接受 ADT 单药治疗，338 例（24%）接受 ADT+NSAA 治疗，108 例（8%）接受 ADT+多西他赛治疗，75 例（5%）接受 ADT+阿比特龙治疗。在研究期间，ADT 单药和 ADT+NSAA 的比例分别从 66%降至 60%和从 31%降至 17%，而接受 ADT+多西他赛或阿比特龙治疗的患者比例从 3%增至 9%和从 1%增至 15%。接受 ADT+NSAA 治疗的患者发生去势抵抗性疾病的风险与 ADT 单药治疗相似（风险比[HR]1.05；95%置信区间[CI]：0.87，1.26）和总死亡率（HR 1.22；95%CI：0.97，1.54）。
尽管出现了多西他赛和新型激素疗法，但大多数开始接受 ADT 治疗的 mCSPC 患者接受 ADT 单药或 ADT+NSAA 治疗。即使在最近（2017 年至 2018 年初），与 ADT 单药治疗相比，仅 24%的男性接受了已知可延长生存时间的强化治疗。这些真实世界临床实践中的数据表明，mCSPC 患者的治疗结果仍有很大的改善空间。
