Ferriero Mariaconsiglia, Prata Francesco, Anceschi Umberto, Astore Serena, Bove Alfredo Maria, Brassetti Aldo, Calabrò Fabio, Chiellino Silvia, De Nunzio Cosimo, Facchini Gaetano, Franzese Elisena, Izzo Michela, Mastroianni Riccardo, Misuraca Leonardo, Naspro Richard, Papalia Rocco, Pappalardo Annalisa, Tema Giorgia, Tuderti Gabriele, Turchi Beatrice, Tubaro Andrea, Simone Giuseppe
Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy.
Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy.
Cancers (Basel). 2023 Sep 29;15(19):4809. doi: 10.3390/cancers15194809.
Registrative trials recommended the use of upfront chemotherapy in high-volume metastatic prostate cancer. We reported survival outcomes of patients with high-volume mCRPC treated with ARTA in a chemo-naïve setting compared to patients treated with chemotherapy as first-line from a longitudinal real-life multicenter series. We retrospectively collected data on mCRPC patients treated at six centers. The dataset was queried for high-volume disease (defined as more than 6 bone lesions or bulky nodes ≥ 5 cm). We compared the main clinical features of chemo-naïve versus chemo-treated patients. The Mann-Whitney U test and Chi-squared test were used to compare continuous and categorial variables, respectively. The Kaplan-Meier method was used to compare differences in terms of progression-free survival (PFS), cancer specific survival (CSS) and overall survival (OS) in an upfront ARTA or chemo-treated setting. Survival probabilities were computed at 12, 24, 48, and 60 months. Out of 216 patients, 88 cases with high-volume disease were selected. Sixty-nine patients (78.4%) received upfront ARTA, while 19 patients received chemotherapy as the first-line treatment option. Forty-eight patients received Abiraterone (AA), 21 patients received Enzalutamide (EZ) as the first-line treatment. The ARTA population was older ( = 0.007) and less likely to receive further lines of treatment ( = 0.001) than the chemo-treated cohort. The five-year PFS, CSS and OS were 60%, 73.3%, and 72.9%, respectively. Overall, 28 patients (31.8%) shifted after their first-line therapy to a second-line therapy: EZ was prescribed in 17 cases, AA in seven cases and radiometabolic therapy in four patients. Sixteen cases (18.2%) developed significant progression and were treated with chemotherapy. At Kaplan-Meyer analysis PFS, CSS and OS were comparable for upfront ARTA vs chemo-treated patients (log rank = 0.10, = 0.64 and = 0.36, respectively). We reported comparable survival probabilities in a real-life series of high-volume mCRPC patients who either received upfront ARTA or chemotherapy. Patients primarily treated with chemotherapy were younger and more likely to receive further treatment lines than the upfront ARTA cohort. Our data support the use of novel antiandrogens as first line treatment regardless tumor burden, delaying the beginning of a more toxic chemotherapy in case of significant disease progression.
注册性试验推荐在高负荷转移性前列腺癌中使用初始化疗。我们报告了在未经化疗的情况下接受雄激素受体靶向疗法（ARTA）治疗的高负荷去势抵抗性前列腺癌（mCRPC）患者与作为一线治疗接受化疗的患者相比的生存结果，这些数据来自一个纵向的真实世界多中心系列研究。我们回顾性收集了在六个中心接受治疗的mCRPC患者的数据。在数据集中查询高负荷疾病（定义为超过6处骨转移灶或直径≥5 cm的肿大淋巴结）。我们比较了未接受化疗患者与接受化疗患者的主要临床特征。分别使用Mann-Whitney U检验和卡方检验来比较连续变量和分类变量。采用Kaplan-Meier方法比较在初始ARTA治疗组或化疗治疗组中无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）的差异。计算12、24、48和60个月时的生存概率。在216例患者中，选择了88例高负荷疾病患者。69例患者（78.4%）接受初始ARTA治疗，而19例患者接受化疗作为一线治疗方案。48例患者接受阿比特龙（AA），21例患者接受恩杂鲁胺（EZ）作为一线治疗。与接受化疗的队列相比，接受ARTA治疗的患者年龄更大（P = 0.007），接受后续治疗线的可能性更小（P = 0.001）。五年PFS、CSS和OS分别为60%、73.3%和72.9%。总体而言，28例患者（3
