美国医疗保险人群中转移性去势抵抗性前列腺癌（mCRPC）男性的真实世界治疗模式和总生存情况。
Real-world treatment patterns and overall survival among men with Metastatic Castration-Resistant Prostate Cancer (mCRPC) in the US Medicare population.
机构信息
Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Urology Section, Durham VA Medical Center, Durham, NC, USA.
出版信息
Prostate Cancer Prostatic Dis. 2024 Jun;27(2):327-333. doi: 10.1038/s41391-023-00725-8. Epub 2023 Oct 2.
BACKGROUND
Real-world treatment patterns and survival in metastatic castration-resistant prostate cancer (mCRPC) have not been characterized for the full fee-for-service Medicare population.
METHODS
Men newly diagnosed with mCRPC were identified in Medicare fee-for-service claims during 1/1/2014-6/30/2019. Men had evidence of mCRPC and continuous insurance coverage ≥1 year before and ≥6 months after diagnosis unless patients died. Treatment patterns after diagnosis were described. Survival from mCRPC diagnosis and from start of first-line (1 L) therapy was modeled using Kaplan-Meier analysis.
RESULTS
Among 14,780 men with mCRPC, mean age was 76 and median follow-up after mCRPC was 17.0 months. 22% received no life-prolonging therapy after mCRPC, 78% received ≥1 line of therapy (LOT), 42% underwent ≥2 LOTs, and 20% had ≥3 LOTs. Median time from start of 1 L to next LOT or end of follow-up was 13.7 months, 10.9 months from 2 L start, and 8.9 months from 3 L start. The most common 1 L to 2 L treatment sequences among men with ≥2 lines were NHT followed by a different NHT (33%), chemotherapy followed by NHT (14%), and NHT followed by chemotherapy (13%). For those initiating 1 L treatment with NHTs, only 28% received subsequent treatment with a different class of therapy. Median survival was 25.6 months after mCRPC and 23.4 months following treatment initiation.
CONCLUSIONS
More than 1 in 5 Medicare patients with mCRPC did not receive any life-prolonging therapy, and less than half received 2 L therapy. NHTs were the most common 1 L and 2 L therapies, with patients treated with NHT as 1 L followed by a different NHT for 2 L as the most common treatment sequence. Median survival from diagnosis for all patients was 25.6 months. These data highlight the dramatic undertreatment that occurs for mCRPC patients, particularly for therapies beyond NHTs as well as the common use of sequential NHTs in real-world data.
背景
转移性去势抵抗性前列腺癌（mCRPC）的真实世界治疗模式和生存情况尚未在全自费医疗保险人群中得到描述。
方法
在 2014 年 1 月 1 日至 2019 年 6 月 30 日期间，从医疗保险全自费报销记录中确定了新诊断为 mCRPC 的男性。患者有 mCRPC 的证据，并且在诊断前至少有 1 年的连续保险覆盖期，在诊断后至少有 6 个月的保险覆盖期，除非患者死亡。描述了诊断后的治疗模式。使用 Kaplan-Meier 分析评估 mCRPC 诊断后的生存和一线治疗（1L）开始后的生存。
结果
在 14780 名 mCRPC 男性中，平均年龄为 76 岁，mCRPC 后中位随访时间为 17.0 个月。22%的患者在 mCRPC 后未接受任何延长寿命的治疗，78%的患者接受了≥1 线治疗（LOT），42%的患者接受了≥2 LOTs，20%的患者接受了≥3 LOTs。从 1L 开始到下一线治疗或随访结束的中位时间为 13.7 个月，从 2L 开始的中位时间为 10.9 个月，从 3L 开始的中位时间为 8.9 个月。接受≥2 线治疗的男性中，最常见的 1L 到 2L 治疗顺序是去势治疗（NHT）后再用不同的 NHT（33%）、化疗后再用 NHT（14%）和 NHT 后再用化疗（13%）。对于那些开始用 NHT 进行 1L 治疗的患者，只有 28%的患者随后接受了不同类别的治疗。mCRPC 后中位总生存时间为 25.6 个月，治疗开始后中位生存时间为 23.4 个月。
结论
在接受 mCRPC 治疗的医疗保险患者中，超过 1/5 的患者未接受任何延长寿命的治疗，不到一半的患者接受了 2L 治疗。NHT 是最常见的 1L 和 2L 治疗方法，用 NHT 作为 1L 治疗后再用不同的 NHT 作为 2L 治疗是最常见的治疗顺序。所有患者的中位总生存时间为 25.6 个月。这些数据突出了 mCRPC 患者治疗中存在的严重治疗不足的情况，尤其是对于 NHT 以外的治疗方法以及在真实世界数据中常见的序贯使用 NHT 治疗的情况。
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