Ito Hitoshi, Yaegashi Hiroshi, Okada Yoshiyuki, Shimada Takafumi, Yamaoka Toshihide, Okubo Kazutoshi, Sakamoto Takashi, Mizokami Atsushi
Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan.
Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Cancer Diagn Progn. 2022 Jul 3;2(4):462-470. doi: 10.21873/cdp.10129. eCollection 2022 Jul-Aug.
BACKGROUND/AIM: Radium (Ra)-223 is widely used for treating castration-resistant prostate cancer (CRPC) with bone metastasis based on evidence of increased survival and decreased skeletal-related events. However, the timing of Ra-223 use in the treatment sequence of CRPC remains controversial. Therefore, this study aimed to explore the appropriate patient status for Ra-223 use in the CRPC treatment sequence by examining patients treated with Ra-223 from the time of CRPC diagnosis until death.
The medical records of 67 CRPC patients with bone metastasis who were treated with Ra-223 at two institutes were retrospectively analysed. The impact of 13 factors from the time of CRPC diagnosis until death was analysed using univariate and multivariate Cox hazard ratio models to evaluate the appropriate patient status for Ra-223 treatment.
The median survival time following CRPC diagnosis for all the patient groups was 3.82 years. Univariate analysis identified a higher-than-normal alkaline phosphatase (ALP) level, bone scan indexes ≥2, and prostate-specific antigen (PSA) doubling time <3 months before Ra-223 treatment as predominant adverse prognostic factors. Ra-223 therapy discontinuation was not a significant factor. The survival of CRPC patients with these factors was significantly worse than that of patients without these factors. In the multivariate analysis, a higher-than-normal ALP level at the start of treatment was identified as a poor prognostic factor for mortality.
The appropriate patient status for Ra-223 use includes low bone metastasis burden and well-controlled PSA levels.
背景/目的：基于生存期延长和骨相关事件减少的证据，镭（Ra）-223被广泛用于治疗伴有骨转移的去势抵抗性前列腺癌（CRPC）。然而，Ra-223在CRPC治疗序列中的使用时机仍存在争议。因此，本研究旨在通过检查从CRPC诊断至死亡期间接受Ra-223治疗的患者，探索在CRPC治疗序列中使用Ra-223的合适患者状态。
回顾性分析了两家机构中67例接受Ra-223治疗的伴有骨转移的CRPC患者的病历。使用单因素和多因素Cox风险比模型分析从CRPC诊断至死亡期间13个因素的影响，以评估适合接受Ra-223治疗的患者状态。
所有患者组CRPC诊断后的中位生存时间为3.82年。单因素分析确定，在Ra-223治疗前碱性磷酸酶（ALP）水平高于正常、骨扫描指数≥2以及前列腺特异性抗原（PSA）倍增时间<3个月为主要不良预后因素。停止Ra-223治疗不是一个显著因素。具有这些因素的CRPC患者的生存期明显短于无这些因素的患者。在多因素分析中，治疗开始时ALP水平高于正常被确定为死亡的不良预后因素。
使用Ra-223的合适患者状态包括低骨转移负担和良好控制的PSA水平。
