Shi Yifu, Wei Xinyuan, Zhao Fengnian, Chen Junru, Sun Guangxi, Zhang Xingming, Liang Jiayu, Hu Xu, Shen Pengfei, Liu Zhenhua, Nie Ling, Chen Ni, Zhao Jinge, Zeng Hao
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 May;85(7):659-669. doi: 10.1002/pros.24869. Epub 2025 Mar 4.
The prognostic value of the prostate adenocarcinoma (PAC) with ductal feature in patients with advanced prostate cancer treated with abiraterone acetate has not been scrutinized. This study aims to explore the predictive value of PAC with ductal feature on the therapeutic efficacy of abiraterone therapy in metastatic prostate cancer (mPCa) patients.
We retrospectively analyzed data from 569 patients with mPCa receiving abiraterone at either the metastatic hormone-sensitive (mHSPC, N = 165) or castration-resistant prostate cancer (mCRPC, N = 404) stage. PSM was performed to balance the baseline characteristics between individuals with and without ductal features. Kaplan-Meier curves and Cox regression were used to analyze the predictive significance of ductal feature on abiraterone efficacy, including PSA response, PSA progression-free survival (PSA-PFS), radiographic progression-free survival (rPFS), and overall survival (OS).
Totally, ductal feature was detected in 40/569 (7.0%) men, with 18 and 22 in the mHSPC and mCRPC cohorts, respectively. The PSA response rate was comparable for people with and without ductal features for both cohorts. Notably, in the mHSPC cohort, patients with and without ductal features shared similar median PSA-PFS (not reached vs. 32.6-months, p = 0.593) and rPFS (not reached vs. 35.0-months, p = 0.768). Similar results were observed in the mCRPC cohort (median PSA-PFS: 21.2- vs. 11.6-months, p = 0.100; median rPFS: 34.6- vs. 18.7-months, p = 0.092). COX regression further revealed that ductal feature was not an indicator of unfavorable PSA-PFS or rPFS in the mHSPC and mCRPC cohort.
In conclusion, our findings indicated that there is insufficient evidence to differentiate the therapeutic efficacy of AA in mPCa based on the presence or absence of ductal features. However, further validation through larger-scale studies is required to substantiate them.
醋酸阿比特龙治疗的晚期前列腺癌患者中，具有导管特征的前列腺腺癌（PAC）的预后价值尚未得到仔细研究。本研究旨在探讨具有导管特征的PAC对转移性前列腺癌（mPCa）患者阿比特龙治疗疗效的预测价值。
我们回顾性分析了569例接受阿比特龙治疗的mPCa患者的数据，这些患者处于转移性激素敏感性（mHSPC，N = 165）或去势抵抗性前列腺癌（mCRPC，N = 404）阶段。进行倾向评分匹配（PSM）以平衡有无导管特征个体之间的基线特征。采用Kaplan-Meier曲线和Cox回归分析导管特征对阿比特龙疗效的预测意义，包括PSA反应、PSA无进展生存期（PSA-PFS）、影像学无进展生存期（rPFS）和总生存期（OS）。
总共在40/569（7.0%）男性中检测到导管特征，mHSPC和mCRPC队列中分别有18例和22例。两个队列中有无导管特征的患者PSA反应率相当。值得注意的是，在mHSPC队列中，有无导管特征的患者中位PSA-PFS相似（未达到 vs. 32.6个月，p = 0.593）和rPFS相似（未达到 vs. 35.0个月，p = 0.768）。在mCRPC队列中也观察到类似结果（中位PSA-PFS：21.2个月 vs. 11.6个月，p = 0.100；中位rPFS：34.6个月 vs. 18.7个月，p = 0.09）。COX回归进一步显示，在mHSPC和mCRPC队列中，导管特征不是PSA-PFS或rPFS不良的指标。
总之，我们的研究结果表明，没有足够的证据基于有无导管特征来区分醋酸阿比特龙在mPCa中的治疗效果。然而，需要通过更大规模的研究进行进一步验证以证实这些结果。
