Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Urology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Sayama, Osaka, 589-8511, Japan.
Int J Clin Oncol. 2023 Mar;28(3):427-435. doi: 10.1007/s10147-022-02288-5. Epub 2022 Dec 29.
Enzalutamide is effective against castration-resistant prostate cancer (CRPC). However, it is unclear which patients would benefit more from enzalutamide treatment. Here, we analyzed patients who received enzalutamide as first-line therapy for CRPC and evaluated the factors that predict treatment response and prognosis.
We retrospectively analyzed 101 patients treated with enzalutamide for CRPC at our institution. As primary endpoints we regarded the prostate-specific antigen (PSA) response rate and PSA-progression-free survival (PSA-PFS) from the start of enzalutamide treatment. Laboratory and imaging data were analyzed to predict treatment efficacy.
PSA reductions of ≥ 50% and ≥ 90% were observed in 78 (77%) and 47 (47%) patients, respectively, compared with the baseline. During the follow-up period, 67 (66%) patients showed PSA progression, with a median PSA-PFS of 11 months. Moreover, 31 patients (31%) died, with a median overall survival of 64 months. On multivariate analysis, lymph node metastases at the start of enzalutamide treatment [odds ratio (OR) 0.0575, 95% confidence interval (CI) 0.0105-0.316, p = 0.0010] and time to CRPC (OR 0.177, 95% CI 0.0428-0.731, p = 0.0167] were associated with ≥ 90% PSA response. Lymph node metastases (hazard ratio [HR] 3.00, 95% CI 1.48-6.09, p = 0.0023) and time to CRPC (HR 1.84, 95% CI 1.02-3.30, p = 0.0419) were also predictors of PSA-PFS on a multivariate model.
Time to CRPC and lymph node metastasis were predictors of the PSA response rate and PSA-PFS.
恩扎卢胺对去势抵抗性前列腺癌（CRPC）有效。然而，尚不清楚哪些患者将从恩扎卢胺治疗中获益更多。在这里，我们分析了在我们机构接受恩扎卢胺作为 CRPC 一线治疗的患者，并评估了预测治疗反应和预后的因素。
我们回顾性分析了在我们机构接受恩扎卢胺治疗的 101 例 CRPC 患者。以开始恩扎卢胺治疗后的前列腺特异性抗原（PSA）反应率和 PSA 无进展生存期（PSA-PFS）作为主要终点。分析实验室和影像学数据以预测治疗效果。
与基线相比，78 例（77%）和 47 例（47%）患者分别观察到 PSA 降低≥50%和≥90%。在随访期间，67 例（66%）患者出现 PSA 进展，PSA-PFS 的中位数为 11 个月。此外，31 例（31%）患者死亡，中位总生存期为 64 个月。多变量分析显示，恩扎卢胺治疗开始时的淋巴结转移[优势比（OR）0.0575，95%置信区间（CI）0.0105-0.316，p=0.0010]和 CRPC 时间（OR 0.177，95%CI 0.0428-0.731，p=0.0167）与 PSA≥90%的反应相关。淋巴结转移（风险比[HR]3.00，95%CI 1.48-6.09，p=0.0023）和 CRPC 时间（HR 1.84，95%CI 1.02-3.30，p=0.0419）也是 PSA-PFS 的多变量模型预测因素。
CRPC 时间和淋巴结转移是 PSA 反应率和 PSA-PFS 的预测因素。
