骨修饰剂对镭-223治疗中的有症状骨事件具有保护作用。

Bone-modifying agents are protective for symptomatic skeletal events in Radium-223 treatment.

作者信息

Blas Leandro, Shiota Masaki, Matsumoto Takashi, Hori Yoshifumi, Nakamura Motonobu, Seki Narihito, Kuroiwa Kentaro, Yokomizo Akira, Morokuma Futoshi, Kiyoshima Keijiro, Eto Masatoshi

机构信息

Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Department of Urology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan.

出版信息

Int J Urol. 2023 Nov;30(11):1029-1034. doi: 10.1111/iju.15259. Epub 2023 Jul 27.

DOI:10.1111/iju.15259

PMID:37501328

Abstract

INTRODUCTION

Radium-223 (Ra-223) dichloride therapy increases overall survival and delays time to the first symptomatic skeletal event (SSE) in patients with castration-resistant prostate cancer (CRPC) and bone metastases. Bone-modifying agents (BMA) reduce SSE in patients with bone metastasis, but there is little information on their use with Ra-223. This study aimed to investigate the effect of BMA on SSE in patients with bone metastatic CRPC treated with Ra-223 in real-world practice.

METHODS

We included 73 patients treated with Ra-223 from 10 institutions in Japan. Time to the first SSE was estimated using the Kaplan-Meier method and compared between groups using the log-rank test. We used univariate analysis to ascertain the association between variables and SSE.

RESULTS

During a median follow-up of 12.7 months (interquartile range, 7-21.7), 12 (16.4%) patients presented SSE. Age and BMA use were different between men with and without SSE. The 1-year SSE-free survival rate from Ra-223 treatment initiation was 82.4% (95% CI, 69.4%-90.2%). BMA use was associated with favorable SSE-free survival (hazard risk, 0.23; 95% confidence interval, 0.061-0.85; p = 0.027). Two (4.7%) and seven (23.3%) patients presented symptomatic pathological bone fracture in groups with and without BMA use, respectively (p = 0.017).

CONCLUSION

This study stresses the importance of BMA use in patients with CRPC and bone metastases in Ra-223 treatment.

摘要

引言

二氯化镭-223（Ra-223）疗法可提高去势抵抗性前列腺癌（CRPC）伴骨转移患者的总生存率，并延迟首次出现有症状骨相关事件（SSE）的时间。骨改良剂（BMA）可减少骨转移患者的SSE，但关于其与Ra-223联合使用的信息较少。本研究旨在调查在实际临床中，BMA对接受Ra-223治疗的骨转移性CRPC患者SSE的影响。

方法

我们纳入了来自日本10家机构的73例接受Ra-223治疗的患者。采用Kaplan-Meier法估计首次SSE的时间，并使用对数秩检验在组间进行比较。我们采用单因素分析确定变量与SSE之间的关联。

结果

在中位随访12.7个月（四分位间距，7-21.7个月）期间，12例（16.4%）患者出现SSE。有SSE和无SSE的男性患者在年龄和BMA使用方面存在差异。从开始使用Ra-223治疗起，1年无SSE生存率为82.4%（95%CI，69.4%-90.2%）。使用BMA与较好的无SSE生存相关（风险比，0.23；95%置信区间，0.061-0.85；p=0.027）。使用BMA组和未使用BMA组分别有2例（4.7%）和7例（23.3%）患者出现有症状的病理性骨折（p=0.017）。