Wei Xinyuan, Zhao Jinge, Nie Ling, Shi Yifu, Zhao Fengnian, Shen Yu, Chen Junru, Sun Guangxi, Zhang Xingming, Liang Jiayu, Hu Xu, Shen Pengfei, Chen Ni, Zeng Hao, Liu Zhenhua
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
Prostate. 2025 Feb;85(2):130-139. doi: 10.1002/pros.24809. Epub 2024 Oct 28.
This study explored the value of intraductal carcinoma of the prostate (IDC-P) in predicting the efficacy of abiraterone treatment in metastatic hormone-sensitive prostate cancer (mHSPC) patients.
A retrospective study of 925 patients who underwent prostate biopsies to detect IDC-P was conducted, with participants divided into two cohorts. The first cohort of 165 mHSPC patients receiving abiraterone treatment was analyzed to compare therapeutic effectiveness between IDC-P positive and negative cases. Utilizing propensity score matching (PSM) to reduce bias, outcomes such as PSA response, progression-free survival (PSA-PFS), radiographic progression-free survival (rPFS), and overall survival were assessed. Additionally, the second cohort of 760 mHSPC patients compared the efficacy of abiraterone with conventional hormone therapy, focusing on differences between IDC-P positive and negative individuals.
After PSM, our first cohort included 108 patients with similar baseline characteristics. Among them, 50% (54/108) were diagnosed with IDC-P, with 22.2% (12/54) having IDC-P pattern 1 and 77.8% (42/54) with IDC-P pattern 2. While no notable difference was seen in PSA responses between IDC-P positive and negative patients, IDC-P presence linked to worse clinical outcomes (PSA-PFS: 18.6 months vs. not reached [NR], p = 0.009; rPFS: 23.6 months vs. NR, p = 0.020). Further analysis showed comparable outcomes for IDC-P pattern 1 but significantly worse prognosis for IDC-P pattern 2 (PSA-PFS: 18.6 months vs. NR, p = 0.002; rPFS: 22.4 months vs. NR, p = 0.010). Subgroup analysis revealed IDC-P pattern 2 consistently predicted poorer outcomes across patient subgroups. Remarkably, both IDC-P positive and negative patients gained more from androgen deprivation therapy with abiraterone than conventional treatment, with IDC-P negative patients showing a more significant survival advantage, supported by better hazard ratios (0.47 and 0.66).
This study found that IDC-P, especially pattern 2, predicts poor prognosis in mHSPC patients on abiraterone therapy. Also, abiraterone's advantage over hormone therapy is reduced in cases with IDC-P compared to those without.
本研究探讨前列腺导管内癌（IDC-P）在预测转移性激素敏感性前列腺癌（mHSPC）患者阿比特龙治疗疗效方面的价值。
对925例行前列腺活检以检测IDC-P的患者进行回顾性研究，参与者分为两个队列。分析接受阿比特龙治疗的165例mHSPC患者的第一个队列，比较IDC-P阳性和阴性病例的治疗效果。利用倾向评分匹配（PSM）以减少偏倚，评估前列腺特异性抗原（PSA）反应、无进展生存期（PSA-PFS）、影像学无进展生存期（rPFS）和总生存期等结局。此外，760例mHSPC患者的第二个队列比较了阿比特龙与传统激素治疗的疗效，重点关注IDC-P阳性和阴性个体之间的差异。
经过PSM后，我们的第一个队列包括108例基线特征相似的患者。其中，50%（54/108）被诊断为IDC-P，其中22.2%（12/54）为IDC-P模式1，77.8%（42/54）为IDC-P模式2。虽然IDC-P阳性和阴性患者在PSA反应方面未见明显差异，但IDC-P的存在与较差的临床结局相关（PSA-PFS：18.6个月对未达到[NR]，p = 0.009；rPFS：23.6个月对NR，p = 0.020）。进一步分析显示，IDC-P模式1的结局相当，但IDC-P模式2的预后明显更差（PSA-PFS：18.6个月对NR，p = 0.002；rPFS：22.4个月对NR，p = 0.010）。亚组分析显示，IDC-P模式2在各患者亚组中始终预测较差的结局。值得注意的是，IDC-P阳性和阴性患者从阿比特龙雄激素剥夺治疗中比传统治疗获益更多，IDC-P阴性患者显示出更显著的生存优势，更好的风险比（0.47和0.66）支持这一点。
本研究发现，IDC-P，尤其是模式2，预测接受阿比特龙治疗的mHSPC患者预后不良。此外，与无IDC-P的病例相比，有IDC-P的病例中阿比特龙相对于激素治疗的优势降低。
