伴有内脏转移的去势抵抗性前列腺癌患者的发病率和生存率：来自荷兰CAPRI注册研究的结果。
Incidence and survival of castration-resistant prostate cancer patients with visceral metastases: results from the Dutch CAPRI-registry.
作者信息
van den Bergh Gijs P A, Kuppen Malou C P, Westgeest Hans M, Mehra Niven, Gerritsen Winald R, Aben Katja K H, van Oort Inge M, van Moorselaar Reindert J A, Somford Diederik M, van den Eertwegh Alfonsus J M, Bergman André M, van den Bergh Alphonsus C M, Uyl-de Groot Carin A
机构信息
Institute for Medical Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Department of Radiation Oncology, Maastro, Maastricht, The Netherlands.
出版信息
Prostate Cancer Prostatic Dis. 2023 Mar;26(1):162-169. doi: 10.1038/s41391-022-00605-7. Epub 2022 Oct 12.
BACKGROUND
The objective of this real-world population study is to investigate incidence and treatment of visceral metastases (VMs) in castration resistant prostate cancer (CRPC) patients and their survival.
METHODS
CRPC-patients in the CAPRI-registry between 2010 and 2016 were included in the analyses and followed till 2017. Outcomes were proportion of patients radiologically screened for VMs and proportion of patients with VMs at CRPC-diagnosis and at the start of every treatment line. Groups have been created based on location of VMs (lung, liver, or both) at date of first VM diagnosis. The outcome for these groups was overall survival (OS). Statistics included descriptive analyses, Kaplan-Meier method, and Cox proportional hazard regression analysis for survival analyses.
RESULTS
Of 3602 patients from the CAPRI registry, 457 patients (12.7%) were diagnosed with VMs during follow-up: 230 patients with liver, 161 with lung, and 66 with both liver and lung metastases. The proportion of patients radiologically screened for VMs increased per treatment line as did the occurrence rate of VMs. However, 80% of patients at CRPC diagnosis to 40% in the 6th line were not screened for VMs at the start of a systemic treatment. Median OS was 8.6 months for patients with liver, 18.3 with lung and 10.9 with both liver and lung metastases (p < 0.001) from date of first VM diagnosis. After correction for prognostic factors patients with lung metastases had significantly better OS than patients with liver metastases (HR 0.650, p = 0.001).
CONCLUSION
This real-world analysis showed that despite the increased rate of radiological staging during follow-up, still 80% to 40% of the patients (CRPC diagnosis to 6th treatment line respectively) were not screened for VMs at the start of a systemic treatment. VMs and location of VMs are key prognostic patient characteristics, impacts survival and have implications for treatment decisions, so routine staging of CRPC-patients is warranted.
CLINICAL TRIAL IDENTIFICATION
The CAPRI study is registered in the Dutch Trial Registry as NL3440 (NTR3591).
背景
本真实世界人群研究的目的是调查去势抵抗性前列腺癌（CRPC）患者内脏转移（VMs）的发生率、治疗情况及其生存率。
方法
纳入2010年至2016年CAPRI注册研究中的CRPC患者进行分析，并随访至2017年。观察指标为接受VMs影像学筛查的患者比例，以及在CRPC诊断时和每个治疗线开始时出现VMs的患者比例。根据首次诊断VMs时VMs的位置（肺、肝或两者皆有）进行分组。这些组的观察指标为总生存期（OS）。统计分析包括描述性分析、Kaplan-Meier法以及用于生存分析的Cox比例风险回归分析。
结果
在CAPRI注册研究的3602例患者中，457例（12.7%）在随访期间被诊断为VMs：230例为肝转移，161例为肺转移，66例为肝肺转移。接受VMs影像学筛查的患者比例随治疗线增加，VMs的发生率也随之增加。然而，在CRPC诊断时80%的患者至第6线治疗时40%的患者在开始全身治疗时未接受VMs筛查。从首次诊断VMs之日起，肝转移患者的中位OS为8.6个月，肺转移患者为18.3个月，肝肺转移患者为10.9个月（p<0.001）。校正预后因素后，肺转移患者的OS显著优于肝转移患者（HR 0.650，p = 0.001）。
结论
本真实世界分析表明，尽管随访期间影像学分期率有所提高，但仍有80%至40%的患者（分别为CRPC诊断时和第6线治疗时）在开始全身治疗时未接受VMs筛查。VMs及其位置是患者关键的预后特征，影响生存并对治疗决策有影响，因此CRPC患者进行常规分期是必要的。
临床试验识别
CAPRI研究在荷兰试验注册中心注册为NL3440（NTR3591）。
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