Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany.
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
World J Urol. 2024 Nov 2;42(1):615. doi: 10.1007/s00345-024-05341-2.
Metastatic castration-resistant prostate cancer (mCRPC) patients harbor reduced life expectancy after first-line treatment progression. Currently, no information is available regarding the influence of metastatic sites and osseous burden on progression-free (PFS) and overall survival (OS) of mCRPC patients.
We relied on the Frankfurt Metastatic Cancer Database of the Prostate (FRAMCAP) database to select patients progressing to mCRPC and stratified them according to lymph node vs. osseous vs. visceral metastatic sites. Moreover, we stratified osseous mCRPC patients regarding the number of metastatic lesions. Endpoints were PFS and OS in uni- and multivariable Cox regression models.
Of 363 patients, 9.4% harbored M1a vs. 78% M1b vs. 12% M1c mCRPC with significantly higher PSA in M1b (9 vs. 22 vs. 8ng/ml). Rates of DeNovo (15% vs. 60% vs. 56%) were significantly lower in the M1a mCRPC group, compared to M1b and M1c (p < 0.001). In PFS analyses, a median of 12.7 vs. 10.1 vs. 15.9 months for M1a vs. M1b vs. M1c mCRPC was observed (p > 0.05). In multivariable Cox regression models, M1c mCRPC was independently at higher risk for progression (hazard ratio [HR]: 5.93, p = 0.048), relative to M1a. Regarding OS, significant differences were observed (p = 0.002), with median OS of 58 vs. 42 vs. 25 months for M1a vs. M1b vs. M1c mCRPC and corresponding HRs of 1.54 (p = 0.11) and 2.76 (p < 0.01). In multivariable models M1c mCRPC was associated with higher risk of death (HR: 3.56, p = 0.049), relative to M1a. No differences were observed after stratification according to number of bone lesions (all p ≥ 0.05).
M1c mCRPC patients are independently at higher risk for progression and death, while M1a patients harbor best cancer-control outcomes.
一线治疗进展后，转移性去势抵抗性前列腺癌（mCRPC）患者的预期寿命缩短。目前，尚无关于转移性部位和骨负担对 mCRPC 患者无进展生存期（PFS）和总生存期（OS）影响的信息。
我们依赖于前列腺法兰克福转移性癌症数据库（FRAMCAP）数据库来选择进展为 mCRPC 的患者，并根据淋巴结与骨与内脏转移部位对其进行分层。此外，我们根据转移病变的数量对骨转移的 mCRPC 患者进行分层。终点是单变量和多变量 Cox 回归模型中的 PFS 和 OS。
在 363 名患者中，9.4%的患者为 M1a，78%的患者为 M1b，12%的患者为 M1c mCRPC，M1b 的 PSA 明显更高（9 vs. 22 vs. 8ng/ml）。M1a mCRPC 组的新发转移率（15% vs. 60% vs. 56%）明显低于 M1b 和 M1c 组（p < 0.001）。在 PFS 分析中，M1a、M1b 和 M1c mCRPC 的中位 PFS 分别为 12.7、10.1 和 15.9 个月（p > 0.05）。在多变量 Cox 回归模型中，M1c mCRPC 进展的风险明显更高（风险比[HR]：5.93，p = 0.048），与 M1a 相比。关于 OS，观察到显著差异（p = 0.002），M1a、M1b 和 M1c mCRPC 的中位 OS 分别为 58、42 和 25 个月，相应的 HR 分别为 1.54（p = 0.11）和 2.76（p < 0.01）。在多变量模型中，M1c mCRPC 与死亡风险增加相关（HR：3.56，p = 0.049），与 M1a 相比。根据骨病变数量分层后，没有观察到差异（所有 p≥0.05）。
M1c mCRPC 患者进展和死亡的风险明显更高，而 M1a 患者的癌症控制结果最佳。
