Yanagisawa Takafumi, Kawada Tatsushi, Rajwa Pawel, Mostafaei Hadi, Motlagh Reza Sari, Quhal Fahad, Laukhtina Ekaterina, König Frederik, Pallauf Maximilian, Pradere Benjamin, Karakiewicz Pierre I, Nyirady Peter, Kimura Takahiro, Egawa Shin, Shariat Shahrokh F
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Urol Oncol. 2023 Apr;41(4):177-191. doi: 10.1016/j.urolonc.2022.06.018. Epub 2022 Aug 13.
Cabazitaxel is an effective treatment of post-docetaxel metastatic castration-resistant prostate cancer (mCRPC). We aimed to assess the sequencing impact and identify prognostic factors of oncologic outcomes in mCRPC patients treated with cabazitaxel.
PUBMED, Web of Science, and Scopus databases were searched for articles published before January 2022 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Studies were deemed eligible if they investigated pretreatment clinical or hematological prognostic factors of overall survival (OS) in mCRPC patients with progression after docetaxel treated with available treatments including cabazitaxel.
Overall, 22 studies were eligible for the meta-analysis. In mCRPC patients treated with docetaxel, subsequent treatment with cabazitaxel was associated with better OS compared to that without cabazitaxel (pooled hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.56-0.89). Among the patients treated with cabazitaxel, several pretreatment clinical features and hematologic biomarkers were associated with worse OS as follows: poor performance status (PS) (pooled HR: 1.92, 95% CI: 1.33-2.77), presence of visceral metastasis (pooled HR: 2.13, 95% CI: 1.62-2.81), symptomatic disease (pooled HR: 1.47, 95% CI: 1.25-1.73), high PSA (pooled HR: 1.76, 95% CI: 1.27-2.44), high alkaline phosphatase (ALP) (pooled HR: 1.45, 95% CI: 1.28-1.65), high lactate dehydrogenase (LDH) (pooled HR: 1.54, 95% CI: 1.00-2.38), high c-reactive protein (CRP) (pooled HR: 4.40, 95% CI: 1.52-12.72), low albumin (pooled HR:1.09, 95% CI: 1.05-1.12) and low hemoglobin (pooled HR:1.55, 95% CI: 1.20-1.99).
Sequential therapy with cabazitaxel significantly improves OS in post-docetaxel mCRPC patients. In mCRPC patients treated with cabazitaxel, patients with poor PS, visceral metastasis, and symptomatic disease were associated with worse OS. Further, pretreatment high PSA, ALP, LDH or CRP as well as low hemoglobin or albumin, were blood-based prognostic factors for OS. These findings might help guide the clinical decision-making for the use of cabazitaxel and prognostication of its OS benefit.
卡巴他赛是多西他赛后转移性去势抵抗性前列腺癌（mCRPC）的有效治疗方法。我们旨在评估测序影响，并确定接受卡巴他赛治疗的mCRPC患者肿瘤学预后的预后因素。
根据PRISMA（系统评价和Meta分析的首选报告项目）声明，检索了PUBMED、Web of Science和Scopus数据库中2022年1月之前发表的文章。如果研究调查了多西他赛后进展的mCRPC患者接受包括卡巴他赛在内的可用治疗后总生存（OS）的治疗前临床或血液学预后因素，则被认为符合条件。
总体而言，22项研究符合Meta分析的条件。在接受多西他赛治疗的mCRPC患者中，与未接受卡巴他赛治疗相比，后续接受卡巴他赛治疗与更好的OS相关（合并风险比[HR]：0.70，95%置信区间[CI]：0.56-0.89）。在接受卡巴他赛治疗的患者中，以下几种治疗前临床特征和血液生物标志物与较差的OS相关：体能状态（PS）差（合并HR：1.92，95%CI：1.33-2.77）、存在内脏转移（合并HR：2.13，95%CI：1.62-2.81）、有症状疾病（合并HR：1.47，95%CI：1.25-1.73）、高前列腺特异性抗原（PSA）（合并HR：1.76，95%CI：1.27-2.44）、高碱性磷酸酶（ALP）（合并HR：1.45，95%CI：1.28-1.65）、高乳酸脱氢酶（LDH）（合并HR：1.54，95%CI：1.00-2.38）、高C反应蛋白（CRP）（合并HR：4.40，95%CI：1.52-12.72）、低白蛋白（合并HR：1.09，95%CI：1.05-1.12）和低血红蛋白（合并HR：1.55，95%CI：1.20-1.99）。
卡巴他赛序贯治疗显著改善了多西他赛后mCRPC患者的OS。在接受卡巴他赛治疗的mCRPC患者中，PS差、内脏转移和有症状疾病的患者OS较差。此外，治疗前高PSA、ALP、LDH或CRP以及低血红蛋白或白蛋白是OS的血液学预后因素。这些发现可能有助于指导卡巴他赛使用的临床决策及其OS获益的预后评估。
