Roy Soumyajit, Morgan Scott C, Wallis Christopher J D, Sun Yilun, Spratt Daniel E, Malone Julia, Grimes Scott, Mukherjee Dibya, Kishan Amar U, Saad Fred, Malone Shawn
Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA.
Radiation Medicine Program, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.
Prostate Cancer Prostatic Dis. 2023 Mar;26(1):96-104. doi: 10.1038/s41391-022-00529-2. Epub 2022 Sep 13.
Pain is an important dimension of quality-of-life in patients with metastatic castrate-sensitive prostate cancer (mCSPC). However, it is unclear if dynamic change in pain over time can predict for overall survival (OS) or progression-free survival (PFS) in these patients.
This is an exploratory analysis of LATITUDE, a phase III randomized study, in which men with de novo mCSPC were randomized to receive either ADT plus abiraterone versus ADT alone. Information was collected on patient-reported worst pain score (WPS) and pain-interference score (PIS) from the Brief Pain Inventory-Short Form. A Bayesian joint modelling approach was used determine the association of dynamic change in WPS and PIS with OS and PFS.
Overall, 1125 patients with at least 3 measurements on pain scores were eligible. On Cox multivariable regression, increase in baseline WPS was associated with inferior OS (hazard ratio [HR] 1.049 [95% confidence intervals [CI] 1.015-1.085]; time dependent area under curve [tAUC] 0.64) and PFS (HR 1.045 [1.011-1.080]; tAUC: 0.64). Increase in baseline PIS was associated with inferior OS (HR 1.062 [1.020-1.105]; tAUC: 0.63) but not with PFS (HR 1.038 [0.996-1.08]). On independent joint models, an increase in the current value of WPS by 1-unit was associated with inferior OS (HR 1.316 [1.258-1.376]; tAUC 0.74) and PFS (HR 1.319 [1.260-1.382]; tAUC 0.70). Similar association was seen for increase in the current value of PIS with OS (HR 1.319 [1.261-1.381]; tAUC 0.73) and PFS (HR 1.282 [1.224-1.344]; tAUC 0.73).
The above findings highlight the potential dynamic interplay between patient-reported pain with OS and PFS in mCSPC. Compared to baseline pain, such dynamic assessment of pain was found to have superior predictive ability and thus has the potential to tailor subsequent treatment based on response to initial therapy beyond its role as a very important dimension of quality-of-life.
疼痛是转移性去势敏感性前列腺癌（mCSPC）患者生活质量的一个重要方面。然而，这些患者疼痛随时间的动态变化是否能预测总生存期（OS）或无进展生存期（PFS）尚不清楚。
这是对LATITUDE这一III期随机研究的探索性分析，其中初发mCSPC男性被随机分配接受雄激素剥夺治疗（ADT）联合阿比特龙或单纯ADT。通过简明疼痛问卷简表收集患者报告的最严重疼痛评分（WPS）和疼痛干扰评分（PIS）信息。采用贝叶斯联合建模方法确定WPS和PIS的动态变化与OS和PFS的关联。
总体而言，1125例至少有3次疼痛评分测量的患者符合条件。在Cox多变量回归分析中，基线WPS升高与较差的OS（风险比[HR]1.049[95%置信区间[CI]1.015 - 1.085]；曲线下时间依赖性面积[tAUC]0.64）和PFS（HR 1.045[1.011 - 1.080]；tAUC：0.64）相关。基线PIS升高与较差的OS相关（HR 1.062[1.020 - 1.105]；tAUC：0.63），但与PFS无关（HR 1.038[0.996 - 1.08]）。在独立联合模型中，WPS当前值增加1个单位与较差的OS（HR 1.316[1.258 - 1.376]；tAUC 0.74）和PFS（HR 1.319[1.260 - 1.382]；tAUC 0.70）相关。PIS当前值增加与OS（HR 1.319[1.261 - 1.381]；tAUC 0.73）和PFS（HR 1.
