Noda Michio, Kawai Taketo, Hagiwara Kanade, Yoshida Takahiro, Yanagida Kazuki, Tokura Yuumi, Yoshimura Itsuki, Kaneko Tomoyuki, Nakagawa Tohru
Department of Urology, Teikyo University School of Medicine, Tokyo, Japan.
Glob Health Med. 2024 Jun 30;6(3):199-203. doi: 10.35772/ghm.2024.01019.
In recent years, randomized controlled trials have demonstrated that upfront androgen receptor signaling inhibitors (ARSIs) prolong overall survival (OS) compared with androgen deprivation therapy (ADT) alone or combined androgen blockade (CAB) in patients with metastatic castration-sensitive prostate cancer (mCSPC). However, it remains unclear whether upfront ARSI is superior to CAB in Asian populations, among which the efficacy of ADT/CAB is considered relatively high. In this study, we compared the oncological outcomes of upfront ARSI and CAB in Japanese patients with mCSPC. Patients with mCSPC who underwent systemic therapy between May 2009 and October 2023 were enrolled retrospectively. Propensity score matching (PSM) was performed to compare the castration-resistant prostate cancer-free survival (CRPC-FS), cancer-specific survival (CSS), and OS between patients treated with upfront ARSI (ARSI group) and those treated with CAB (CAB group). In total, 30 and 142 patients were enrolled in the ARSI and CAB groups, respectively. After PSM (25 patients in each group), CRPC-FS was significantly longer in the ARSI group than in the CAB group (median: 36.7 12.3 months, hazard ratio: 0.44, 95% confidence interval: 0.20-0.97, = 0.035). No significant differences were observed in CSS or OS between the two groups. In conclusion, when compared to CAB, upfront ARSI might have the potential to extend CRPC-FS among individuals in the Japanese population.
近年来，随机对照试验表明，对于转移性去势敏感性前列腺癌（mCSPC）患者，与单纯雄激素剥夺治疗（ADT）或联合雄激素阻断（CAB）相比，一线使用雄激素受体信号抑制剂（ARSIs）可延长总生存期（OS）。然而，在亚洲人群中，一线使用ARSIs是否优于CAB仍不清楚，在亚洲人群中，ADT/CAB的疗效被认为相对较高。在本研究中，我们比较了日本mCSPC患者一线使用ARSIs和CAB的肿瘤学结局。回顾性纳入了2009年5月至2023年10月期间接受全身治疗的mCSPC患者。进行倾向评分匹配（PSM）以比较一线使用ARSIs治疗的患者（ARSIs组）和接受CAB治疗的患者（CAB组）之间去势抵抗性前列腺癌无进展生存期（CRPC-FS）、癌症特异性生存期（CSS）和OS。ARSIs组和CAB组分别纳入了30例和142例患者。经过PSM（每组25例患者）后，ARSIs组的CRPC-FS显著长于CAB组（中位数：36.7对12.3个月，风险比：0.44，95%置信区间：0.20-0.97，P = 0.035）。两组之间在CSS或OS方面未观察到显著差异。总之，与CAB相比时一线使用ARSIs可能有潜力延长日本人群个体中的CRPC-FS。
