Sentana-Lledo Daniel, Chu Xiangying, Jarrard David F, Carducci Michael A, DiPaola Robert S, Wagner Lynn I, Cella David, Sweeney Christopher J, Morgans Alicia K
Beth Israel Deaconess Medical Center, Boston, MA, USA.
Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA, USA.
Eur Urol Oncol. 2025 Feb;8(1):29-37. doi: 10.1016/j.euo.2024.04.010. Epub 2024 Apr 30.
Chemohormonal therapy with androgen deprivation therapy and docetaxel (ADT + D) improves overall survival (OS) and quality of life (QOL) at 12 mo versus androgen deprivation therapy (ADT) alone in men with metastatic hormone-sensitive prostate cancer (mHSPC). However, the prognostic role of QOL is unknown in this population.
To study the relationship between QOL, disease characteristics, and OS in men with mHSPC.
DESIGN, SETTING, AND PARTICIPANTS: In this exploratory post hoc analysis, 790 patients with mHSPC completed the QOL instruments Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and Brief Pain Inventory (BPI).
Log-rank test and Cox proportional hazard models tested the association between QOL and OS by clinical and disease characteristics.
Baseline higher FACT-P trended toward improved survival after accounting for clinical variables (hazard ratio [HR] 0.80 [0.62, 1.04], p = 0.09), while higher 3-mo FACT-P was independently associated with better survival (HR 0.76 [0.58, 1.0], p = 0.05). Patients with the poorest QOL (bottom quartile) at baseline and 3 mo had longer survival if they received ADT + D rather than ADT alone (median OS 45.2 vs 34.4 mo, HR 0.75 [0.53, 1.05], p = 0.09, and 48.3 vs 29.3 mo, HR 0.69 [0.48, 0.99], p = 0.05 respectively). In contrast, patients with the best QOL (top quartile) at baseline and 3 mo had comparable survival irrespective of whether or not docetaxel was added (median OS 72.1 vs 51.7 mo, HR 0.92 [0.63, 1.36], p = 0.69, and 69.9 vs 68.9 mo, HR 1.11 [0.73, 1.67], p = 0.63, respectively). Survival was linked with baseline FACIT-F (HR 0.76 [0.57, 1.0], p = 0.05), but not BPI (HR 0.98 [0.75, 1.28], p = 0.90).
Three-month QOL had a stronger independent association with survival. The most symptomatic patients had longer survival with the addition of docetaxel; conversely, the least symptomatic patients did not appear to benefit. Consideration of QOL may enhance decision-making and patient selection when choosing chemohormonal treatment in mHSPC.
Quality of life independently forecasted the survival of men with metastatic hormone-sensitive prostate cancer in the CHAARTED study. Close tracking of quality of life could help patients and clinicians make decisions about the appropriate treatment in this setting.
对于转移性激素敏感性前列腺癌（mHSPC）男性患者，雄激素剥夺疗法联合多西他赛的化学激素疗法（ADT + D）与单纯雄激素剥夺疗法（ADT）相比，可在12个月时改善总生存期（OS）和生活质量（QOL）。然而，QOL在该人群中的预后作用尚不清楚。
研究mHSPC男性患者的QOL、疾病特征与OS之间的关系。
设计、背景与参与者：在这项探索性事后分析中，790例mHSPC患者完成了QOL评估工具癌症治疗功能评估-前列腺（FACT-P）、慢性病治疗功能评估-疲劳（FACIT-F）和简明疼痛量表（BPI）。
对数秩检验和Cox比例风险模型通过临床和疾病特征检验QOL与OS之间的关联。
在考虑临床变量后，基线FACT-P较高者生存有改善趋势（风险比[HR] 0.80 [0.62, 1.04]，p = 0.09），而3个月时FACT-P较高与更好的生存独立相关（HR 0.76 [0.58, 1.0]，p = 0.05）。基线和3个月时QOL最差（四分位间距底部）的患者若接受ADT + D而非单纯ADT，生存期更长（中位OS 45.2对34.4个月，HR 0.75 [0.53, 1.05]，p = 0.09；以及48.3对29.3个月，HR 0.69 [0.48, 0.99]，p = 0.05）。相反，基线和3个月时QOL最佳（四分位间距顶部）的患者，无论是否添加多西他赛，生存期相当（中位OS 72.1对51.7个月，HR 0.92 [0.63, 1.36]，p = 0.69；以及69.9对68.9个月，HR 1.11 [0.73, 1.67]，p = 0.63）。生存与基线FACIT-F相关（HR 0.76 [0.57, 1.0]，p = 0.05），但与BPI无关（HR 0.98 [0.75, 1.28]，p = 0.90）。
3个月时的QOL与生存有更强的独立关联。症状最明显的患者加用多西他赛后生存期更长；相反，症状最轻的患者似乎未从中获益。在mHSPC中选择化学激素治疗时，考虑QOL可能会增强决策制定和患者选择。
在CHAARTED研究中，生活质量独立预测了转移性激素敏感性前列腺癌男性患者的生存。密切跟踪生活质量有助于患者和临床医生在此情况下做出合适治疗的决策。
