寡转移性激素敏感性前列腺癌患者接受转移导向治疗的真实世界结局证据。

Real-world evidence of outcomes of oligometastatic hormone-sensitive prostate cancer patients treated with metastasis-directed therapy.

机构信息

Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.

Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada.

出版信息

Prostate. 2023 Oct;83(14):1365-1372. doi: 10.1002/pros.24599. Epub 2023 Jul 18.

DOI:10.1002/pros.24599

PMID:37464963

Abstract

OBJECTIVE

To investigate characteristics and outcomes of oligometastatic hormone-sensitive prostate cancer (mHSPC) patients undergoing metastases-directed therapy (MDT) with external beam radiation therapy (EBRT).

MATERIALS AND METHODS

We relied on an institutional tertiary-care database to identify mHSPC patients who underwent EBRT as MDT between 12/2019 and 12/2022. Main outcomes consisted of progression to metastatic castration-resistant prostate cancer (mCRPC) and overall mortality (OM). Oligometastatic was defined as ≤3 metastases and bone and/or lymph node deposits were treated with conventional doses up to 54 Gy or with hypofractionated stereotactic regimes of median 24 Gy (20-27 Gy).

RESULTS

Overall, 37 patients treated with EBRT as MDT were identified. The median follow-up was 13 months. Median age at MDT was 71 years and 84% exhibited ECOG performance status 0. The median baseline PSA at diagnosis was 10 ng/mL. Overall, primary local therapy consisted of radical prostatectomy (65%), followed by external beam radiation therapy to the prostate (11%), focal therapy (8%), and palliative transurethral resection of the prostate (5%). Overall, 32% exhibited de novo oligometastatic mHSPC. Bone metastases were present in 78% versus 19% lymph node metastases versus 3% both. The distribution of targeted oligo-metastases was 62% versus 38% for respectively one metastasis versus more than one metastasis. Androgen deprivation therapy (ADT) was combined with MDT in 84%. Moreover, 19% received combination therapy with apalutamide/enzalutamide and 12% with abiraterone or docetaxel. The median time to mCRPC was 50 months. In incidence analyses, 13% developed mCRPC after 24 months. OM after 24 months was 15% in mHSPC patients receiving MDT. Significant OM differences were observed after stratification into targeted metastatic burden (<0.05). No high-grade adverse events were recorded during MDT.

CONCLUSION

Our real-world data suggest that MDT represents a safe treatment option for well-selected oligometastatic mHSPC patients.

摘要

目的

研究接受外照射放射治疗（EBRT）作为转移灶定向治疗（MDT）的寡转移性激素敏感前列腺癌（mHSPC）患者的特征和结局。

材料和方法

我们依靠机构的三级护理数据库，确定了 2019 年 12 月至 2022 年 12 月期间接受 EBRT 作为 MDT 的 mHSPC 患者。主要结局包括进展为转移性去势抵抗性前列腺癌（mCRPC）和总死亡率（OM）。寡转移定义为≤3 个转移灶，且常规剂量治疗的骨和/或淋巴结沉积物达到 54Gy，或接受中位 24Gy（20-27Gy）的低分割立体定向治疗方案。

结果

总共确定了 37 例接受 EBRT 作为 MDT 的患者。中位随访时间为 13 个月。MDT 时的中位年龄为 71 岁，84%的患者表现为 ECOG 体力状况 0。诊断时的中位基线 PSA 为 10ng/mL。总体而言，主要局部治疗包括根治性前列腺切除术（65%），其次是前列腺外照射治疗（11%）、局灶治疗（8%）和经尿道前列腺电切术姑息治疗（5%）。总体而言，32%的患者表现为新发寡转移 mHSPC。骨转移率为 78%，淋巴结转移率为 19%，两者均为 3%。靶性寡转移灶的分布分别为 62%和 38%，分别为一个转移灶和多个转移灶。84%的患者接受 ADT 联合 MDT。此外，19%的患者接受阿帕鲁胺/恩扎鲁胺联合治疗，12%的患者接受阿比特龙或多西他赛治疗。mCRPC 的中位时间为 50 个月。在发生率分析中，13%的患者在 24 个月后发展为 mCRPC。在接受 MDT 的 mHSPC 患者中，24 个月时的 OM 为 15%。在分层为靶向转移负荷后（<0.05），观察到 OM 存在显著差异。在 MDT 期间未记录到高等级不良事件。