局部区域治疗转移性去势抵抗性前列腺癌对疾病进展的影响：来自多中心队列的真实临床经验。
The impact of locoregional treatments for metastatic castration resistant prostate cancer on disease progression: real life experience from a multicenter cohort.
机构信息
IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy.
Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy.
出版信息
Prostate Cancer Prostatic Dis. 2024 Mar;27(1):89-94. doi: 10.1038/s41391-022-00623-5. Epub 2022 Dec 2.
BACKGROUND
Available data on medical treatment of metastatic castration resistant prostate cancer (mCRPC) support the use of more than one therapy line to delay chemotherapy. We evaluate in a longitudinal real life multicenter cohort, the oncological outcome of mCRPC patients treated with Abiraterone Acetate (AA) and Enzalutamide (EZ) in a chemo-naïve setting, who received locoregional treatments for subsequent development of oligorecurrent disease.
METHODS
We prospectively collected data on chemo-naïve mCRPC patients, who received either AA or EZ as first or second line treatment between Oct-2012 and Nov-2020 at 5 centers. High-volume disease at mCRPC onset was defined as bulky positive nodes (≥5 cm) or more than 6 bone metastases. Survival probabilities were computed at 12, 24, 48 and 60 months after treatment start. The impact of loco-regional treatments on progression free survival (PFS) were assessed with the Kaplan-Meier method and the log-rank test was applied.
RESULTS
Overall, 117 chemo-naive mCRPC patients received a first line therapy. Fifty-seven (48.7%) patients received AA and 60 (51.3%) received EZ. Eight (6.7%) patients underwent salvage chemotherapy after first line failure. Overall, 28 patients shifted to a second line therapy. Two-yr progression-free, cancer-specific and overall survival probabilities were 65.5%, 82.2% and 78.4% respectively. Since diagnosis of mCRPC, oligo progression occurred in 25 patients who received stereotactic radiation therapy (23/25, 92%) focused on metastasis (4 nodal sites and 19 bones) or salvage lymph node dissection (2/25, 8%). At Kaplan-Meier analysis, patients with low volume disease displayed higher PFS probabilities (log rank p = 0.009) and in this subgroup of patients loco-regional treatments had a significant impact on PFS (p = 0.048), while it was negligible in the whole cohort and in patients with high volume disease (p = 0.6 and p = 0.75).
CONCLUSIONS
Low-volume mCRPC patients are exposed to improved PFS and seem to benefit from locoregional treatments.
背景
转移性去势抵抗性前列腺癌（mCRPC）的治疗数据支持使用多种治疗方法来延缓化疗。我们在一项纵向真实世界多中心队列中评估了在化疗前接受醋酸阿比特龙（AA）和恩扎鲁胺（EZ）治疗的 mCRPC 患者的肿瘤学结局，这些患者在随后发生寡复发疾病时接受了局部区域治疗。
方法
我们前瞻性地收集了 2012 年 10 月至 2020 年 11 月在 5 个中心接受 AA 或 EZ 作为一线或二线治疗的化疗前 mCRPC 患者的数据。mCRPC 起始时大体积疾病定义为大阳性淋巴结（≥5cm）或超过 6 个骨转移。从治疗开始后 12、24、48 和 60 个月计算生存概率。使用 Kaplan-Meier 方法评估局部区域治疗对无进展生存期（PFS）的影响，并应用对数秩检验。
结果
总体而言，117 例化疗前 mCRPC 患者接受了一线治疗。57 例（48.7%）患者接受 AA 治疗，60 例（51.3%）接受 EZ 治疗。8 例（6.7%）患者在一线治疗失败后接受了挽救化疗。总体而言，28 例患者转为二线治疗。二线治疗 2 年无进展、癌症特异性和总生存率分别为 65.5%、82.2%和 78.4%。自 mCRPC 诊断以来，25 例寡转移患者接受了立体定向放疗（23/25，92%），放疗部位为转移灶（4 个淋巴结部位和 19 个骨骼）或挽救性淋巴结清扫术（2/25，8%）。在 Kaplan-Meier 分析中，低体积疾病患者显示出更高的 PFS 概率（对数秩检验 p=0.009），并且在这一亚组患者中，局部区域治疗对 PFS 有显著影响（p=0.048），而在整个队列和大体积疾病患者中影响较小（p=0.6 和 p=0.75）。
结论
低体积 mCRPC 患者的 PFS 得到改善，并且似乎受益于局部区域治疗。
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