Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan.
Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
Int J Urol. 2022 Sep;29(9):1079-1084. doi: 10.1111/iju.15008. Epub 2022 Aug 17.
The ALSYMPCA trial revealed radium-223 (Ra-223) to be a life-prolonging agent for bone metastatic castration-resistant prostate cancer (CRPC). However, only 2.8% of enrolled patients in that clinical trial were Asian, and no Japanese patients were enrolled. Several retrospective studies have been published concerning Japanese bone metastatic CRPC patients receiving Ra-223. However, no study has yet reported the correlation between Ra-223 induction and the survival in Japanese bone metastatic CRPC patients. This study investigated the effect of Ra-223 as a life-prolonging agent in a large Japanese healthcare fee database.
A total of around 410 000 prostate cancer patients were extracted from this database, and 25 934 were diagnosed with CRPC. In these patients, the age, date of the CRPC diagnosis, date of Ra-223 induction, and prognosis were analyzed.
A total of 1628 patients received Ra-223, and 6693 patients were diagnosed with bone metastasis CRPC, with the remaining 17 613 patients diagnosed with CRPC without bone metastasis. The patients who completed six courses of Ra-223 showed a significantly more favorable overall and cancer-specific survival than those who received ≤5 courses (p < 0.0001 and p < 0.0001, respectively). For time from CRPC diagnosis date to death, the Ra-223 induction group showed a significantly more favorable prognosis with regard to both the overall and cancer-specific survival than the bone metastatic CRPC patients without Ra-223 (p < 0.0001 and p < 0.0001, respectively).
Bone metastatic CRPC patients who received Ra-223 showed a significantly better prognosis than bone metastatic CPRC patients who did not receive Ra-223.
ALSYMPCA 试验显示镭-223（Ra-223）可延长去势抵抗性前列腺癌（CRPC）伴骨转移患者的生存期。然而，该临床试验中仅有 2.8%的入组患者为亚洲人，且没有日本患者。已发表了几项关于接受镭-223 治疗的日本 CRPC 伴骨转移患者的回顾性研究。但是，尚无研究报告镭-223 诱导与日本 CRPC 伴骨转移患者生存之间的相关性。本研究在一个大型日本医疗费用数据库中调查了镭-223 作为一种延长生命药物的效果。
从该数据库中提取了约 410000 名前列腺癌患者，其中 25934 名诊断为 CRPC。对这些患者的年龄、CRPC 诊断日期、镭-223 诱导日期和预后进行了分析。
共有 1628 名患者接受了镭-223 治疗，6693 名患者诊断为 CRPC 伴骨转移，其余 17613 名患者诊断为 CRPC 但无骨转移。完成 6 个疗程镭-223 治疗的患者的总生存和癌症特异性生存均显著优于接受≤5 个疗程的患者（p<0.0001 和 p<0.0001）。从 CRPC 诊断日期到死亡的时间，镭-223 诱导组的总生存和癌症特异性生存均显著优于未接受镭-223 治疗的 CRPC 伴骨转移患者（p<0.0001 和 p<0.0001）。
接受镭-223 治疗的 CRPC 伴骨转移患者的预后显著优于未接受镭-223 治疗的患者。
