Deek Matthew P, Sutera Philip, Jing Yuezhou, Gao Robert, Rothman Emily, Day Heather, Chang David, Dirix Piet, Armstrong Andrew J, Campbell Bethany, Lopez Campos Fernando, Berenguer Miguel, Ramotar Matthew, Conde-Moreno Antonio, Berlin Alejandro, Bosetti Davide Giovanni, Corcoran Niall, Koontz Bridget, Mercier Carole, Siva Shankar, Pryor David, Ost Piet, Huynh Mai Anh, Kroeze Stephanie, Stish Bradley, Kiess Ana, Trock Bruce, Tran Phuoc T, Gillessen Silke, Sweeney Christopher
Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Eur Urol Oncol. 2024 Dec;7(6):1403-1410. doi: 10.1016/j.euo.2024.03.010. Epub 2024 Apr 3.
Metastasis-directed therapy (MDT) is increasingly being used in oligometastatic castration-sensitive prostate cancer (omCSPC). However, it is currently unclear how to optimally integrate MDT with the standard of care of systemic hormonal therapy.
To report long-term outcomes of MDT alone versus MDT and a defined course of androgen deprivation therapy (ADT) in omCSPC.
DESIGN, SETTING, AND PARTICIPANTS: Here, a multicenter, international retrospective cohort of omCSPC as defined by conventional imaging was reported.
Biochemical progression-free survival (bPFS), distant progression-free survival (dPFS), and combined biochemical or distant progression-free survival (cPFS) were evaluated with Kaplan-Meier and multivariable Cox proportional hazard regression models.
A total of 263 patients were included, 105 with MDT + ADT and 158 with MDT alone. The majority of patients had metachronous disease (90.5%). Five-year bPFS, dPFS, and cPFS were, respectively, 24%, 41%, and 19% in patients treated with MDT + ADT and 11% (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.36-0.64), 29% (HR 0.56, 95% CI 0.40-0.78), and 9% (HR 0.50, 95% CI 0.38-0.67) in patients treated with MDT alone. On a multivariable analysis adjusting for pretreatment variables, the use of ADT was associated with improved bPFS (HR 0.43, p < 0.001), dPFS (HR 0.45, p = 0.002), and cPFS (HR 0.44, p < 0.001).
In this large multi-institutional report, the addition of concurrent ADT to MDT appears to improve time to prostate-specific antigen progression and distant recurrence, noting that about 10% patients had durable control with MDT alone. Ongoing phase 3 studies will help further define treatment options for omCSPC.
Here, we report a large retrospective review evaluating the outcomes of metastasis-directed therapy with or without a limited course of androgen deprivation for patients with oligometastatic castration-sensitive prostate cancer. This international multi-institutional review demonstrates that the addition of androgen deprivation therapy to metastasis-directed therapy (MDT) improves progression-free survival. While a proportion of patients appear to have long-term disease control with MDT alone, further work in biomarker discovery is required to better identify which patients would be appropriate for de-escalated therapy.
转移导向治疗（MDT）越来越多地应用于寡转移去势敏感性前列腺癌（omCSPC）。然而，目前尚不清楚如何将MDT与全身激素治疗的标准治疗方案进行最佳整合。
报告omCSPC患者单纯MDT与MDT联合特定疗程雄激素剥夺治疗（ADT）的长期疗效。
设计、设置和参与者：本文报告了一个多中心、国际性的回顾性队列研究，该队列由传统影像学定义的omCSPC患者组成。
采用Kaplan-Meier法和多变量Cox比例风险回归模型评估生化无进展生存期（bPFS）、远处无进展生存期（dPFS）以及联合生化或远处无进展生存期（cPFS）。
共纳入263例患者，其中105例接受MDT + ADT治疗，158例接受单纯MDT治疗。大多数患者为异时性疾病（90.5%）。MDT + ADT治疗的患者5年bPFS、dPFS和cPFS分别为24%、41%和19%，单纯MDT治疗的患者分别为11%（风险比[HR] 0.48，95%置信区间[CI] 0.36 - 0.64）、29%（HR 0.56，95% CI 0.40 - 0.78）和9%（HR 0.50，95% CI 0.38 - 0.67）。在对预处理变量进行调整的多变量分析中，ADT的使用与改善的bPFS（HR 0.43，p < 0.001）、dPFS（HR 0.45，p = 0.002）和cPFS（HR 0.44，p < 0.001）相关。
在这份大型多机构报告中，MDT联合同期ADT似乎能改善前列腺特异性抗原进展时间和远处复发情况，注意到约10%的患者单纯MDT即可获得持久控制。正在进行的3期研究将有助于进一步明确omCSPC的治疗选择。
在此，我们报告了一项大型回顾性研究，评估寡转移去势敏感性前列腺癌患者接受或不接受有限疗程雄激素剥夺的转移导向治疗的疗效。这项国际多机构研究表明，在转移导向治疗（MDT）中加入雄激素剥夺治疗可改善无进展生存期。虽然一部分患者似乎单纯MDT就能实现长期疾病控制，但仍需要进一步开展生物标志物发现工作，以更好地确定哪些患者适合降阶梯治疗。
