低转移负荷前列腺癌伴非区域淋巴结转移的临床特征及预后因素：减瘤放疗的作用？
Clinical characteristics and prognostic factors of low metastatic burden prostate cancer with non-regional lymph node metastases: role of cytoreductive radiotherapy?
作者信息
Mai Lixin, Liu Ruiqi, Zhang Xinyue, Pan Qiwen, Cai Lingling, Cao Wufei, Li Yonghong, Zhou Fangjian, Gao Jianming, Liu Yang, He Liru
机构信息
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Molecular and Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
出版信息
Transl Androl Urol. 2025 Feb 28;14(2):228-239. doi: 10.21037/tau-24-489. Epub 2025 Feb 25.
BACKGROUND
Low metastatic burden prostate cancer (LMBPC) is a special transitional clinical status between localized and disseminated disease, but the clinical prognostic factors and potential therapeutic interventions of those with non-regional lymph node metastases (NRLNM) remain less understood. We aim to explore the prognostic factors and investigate the potential treatment strategy for LMBPC patients with NRLNM.
METHODS
There were 88 patients retrospectively identified. Kaplan-Meier method and Cox proportional hazards model were used for prognostic analyses. Patients receiving non-regional lymph node (NRLN) radiotherapy (NRLN RT group) after prostate-directed local therapy were matched to patients without NRLN RT (control group) by propensity score matching (PSM).
RESULTS
The majority of patients had Gleason score >8 (61.4%), retroperitoneal metastases (93.2%), upward NRLNM (78.4%) and hormone-sensitive prostate cancer (HSPC) (68.2%) at diagnosis. Patients with upward NRLNM showed better survival outcome (75.4 32.8 months, P=0.04). HSPC [hazard ratio (HR) =0.32, P=0.003], bone metastases (HR =3.79, P<0.001), androgen-receptor-axis-targeted agents (ARATAs) (HR =0.40, P=0.007), and notably, NRLN RT (HR =0.23, P=0.001) were independent prognostic factors of overall survival (OS). The median follow-up was 43.3 months. The prostate-specific antigen (PSA) response and median progression-free survival (PFS) after NRLN RT were 70.6% and 29.5 months. The 4-year OS for NRLN RT group and control group were 62% and 46% (P=0.04). After PSM, NRLN RT was still associated with improved OS (HR =0.39, P=0.04). No grade ≥3 NRLN RT-related adverse event was observed.
CONCLUSIONS
Upward NRLNM was the main pattern for LMBPC with NRLNM and associated with better clinical outcome. HSPC, bone metastases, ARATAs and NRLN RT were independent prognostic factors. Applying cytoreductive RT to NRLNM may benefit LMBPC patients. Further studies are still needed.
背景
低转移负荷前列腺癌（LMBPC）是局限性疾病和播散性疾病之间一种特殊的过渡临床状态，但对于那些有非区域淋巴结转移（NRLNM）患者的临床预后因素和潜在治疗干预仍了解较少。我们旨在探索LMBPC伴NRLNM患者的预后因素，并研究其潜在治疗策略。
方法
回顾性纳入88例患者。采用Kaplan-Meier法和Cox比例风险模型进行预后分析。通过倾向评分匹配（PSM），将前列腺局部治疗后接受非区域淋巴结（NRLN）放疗的患者（NRLN RT组）与未接受NRLN RT的患者（对照组）进行匹配。
结果
大多数患者在诊断时Gleason评分>8（61.4%）、有腹膜后转移（93.2%）、向上NRLNM（78.4%）和激素敏感性前列腺癌（HSPC）（68.2%）。向上NRLNM的患者生存结局较好（75.4±32.8个月，P=0.04）。HSPC[风险比（HR）=0.32，P=0.003]、骨转移（HR =3.79，P<0.001）、雄激素受体轴靶向药物（ARATAs）（HR =0.40，P=0.007），以及特别值得注意的是，NRLN RT（HR =0.23，P=0.001）是总生存（OS）的独立预后因素。中位随访时间为43.3个月。NRLN RT后的前列腺特异性抗原（PSA）反应和中位无进展生存（PFS）分别为70.6%和29.5个月。NRLN RT组和对照组的4年OS分别为62%和46%（P=0.04）。PSM后，NRLN RT仍与OS改善相关（HR =0.39，P=0.04）。未观察到≥3级与NRLN RT相关的不良事件。
结论
向上NRLNM是LMBPC伴NRLNM的主要模式，且与较好的临床结局相关。HSPC、骨转移、ARATAs和NRLN RT是独立的预后因素。对NRLNM应用减瘤放疗可能使LMBPC患者获益。仍需进一步研究。
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