Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, No.1, Jen Ai road, Section 1, Taipei, Taiwan.
Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
BMC Cancer. 2023 Jun 20;23(1):568. doi: 10.1186/s12885-023-10885-4.
To investigate the survival outcomes of metastatic castration-resistant prostate cancer (mCRPC) patients receiving first-line novel androgen receptor axis-targeted therapies (ARATs) and prognostic factors for patient survival.
This retrospective study obtained data from 202 patients who started abiraterone acetate or enzalutamide as first-line therapy for mCRPC between 2016 and 2021 from a single academic center. The primary endpoint was overall survival (OS) defined as the interval from the start of ARAT to death, loss to follow-up, or the end of the study period. The secondary endpoints were PSA decline, PSA nadir, and time to nadir (TTN) after ARATs. Kaplan-Meier survival analyses were applied for depicting OS. Cox proportional hazards model with inversed probability of treatment weighing-adjustment was used to validate the effect of patient, disease, and treatment response factors on OS.
Among 202 patients, 164 patients were treated with first-line ARATs alone and 38 patients received second-line chemotherapy. The median OS was not reached in patients with first-line ARATs alone and was 38.8 months in those with subsequent chemotherapy after failure from ARATs. OS was not different between the use of abiraterone and enzalutamide, though enzalutamide showed a higher rate of PSA decline ≧ 90% (56% versus 40%, p = 0.021) and longer TTN (5.5 versus 4.7 months, p = 0.019). Multivariable analysis showed that PSA nadir > 2 ng/mL [hazard ratio (HR) 7.04, p < 0.001] and TTN<7 months (HR 2.18, p = 0.012) were independently associated with shorter OS. Patients with both of these poor prognostic factors had worse OS compared to those who had 0-1 factors (HR 9.21, p < 0.001).
Patients with mCRPC who received first-line ARATs had better survival if they had a PSA nadir[Formula: see text]2 ng/mL or a TTN[Formula: see text]7 months. Further study is needed to determine if an early switch in therapy for those in whom neither is achieved may impact OS.
研究接受一线新型雄激素受体轴靶向治疗（ARAT）的转移性去势抵抗性前列腺癌（mCRPC）患者的生存结果和患者生存的预后因素。
本回顾性研究从单一学术中心 2016 年至 2021 年期间开始使用醋酸阿比特龙或恩扎卢胺作为一线治疗的 202 例 mCRPC 患者中获得数据。主要终点是定义为从 ARAT 开始到死亡、随访丢失或研究结束的总生存期（OS）。次要终点是 PSA 下降、PSA 最低值和 ARAT 后 PSA 最低值时间（TTN）。Kaplan-Meier 生存分析用于描述 OS。采用逆概率治疗加权调整的 Cox 比例风险模型验证患者、疾病和治疗反应因素对 OS 的影响。
在 202 例患者中，164 例患者单独接受一线 ARAT 治疗，38 例患者在一线 ARAT 失败后接受二线化疗。单独接受一线 ARAT 治疗的患者中位 OS 未达到，而接受二线化疗的患者 OS 为 38.8 个月。阿比特龙和恩扎卢胺的 OS 无差异，尽管恩扎卢胺显示出更高的 PSA 下降≧90%（56%比 40%，p=0.021）和更长的 TTN（5.5 比 4.7 个月，p=0.019）。多变量分析显示，PSA 最低值>2ng/mL[风险比（HR）7.04，p<0.001]和 TTN<7 个月（HR 2.18，p=0.012）与较短的 OS 独立相关。与具有 0-1 个不良预后因素的患者相比，具有这两个不良预后因素的患者的 OS 更差（HR 9.21，p<0.001）。
接受一线 ARAT 治疗的 mCRPC 患者，如果 PSA 最低值[Formula: see text]2ng/mL 或 TTN[Formula: see text]7 个月，则生存状况更好。需要进一步研究以确定对于那些未达到这两个指标的患者，早期转换治疗是否会影响 OS。
