A prognostic model for stratifying clinical outcomes in chemotherapy-naive metastatic castration-resistant prostate cancer patients treated with abiraterone acetate
A prognostic model for stratifying clinical outcomes in chemotherapy-naive metastatic castration-resistant prostate cancer patients treated with abiraterone acetate
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DOI：
10.5489/cuaj.4600
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发表时间：
2018-02-01
影响因子：
1.9
通讯作者：
Chi, Kim. N.
中科院分区：
文献类型：
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作者：
Khalaf, Daniel Joseph;Aviles, Claudia M.;Chi, Kim. N.
简介：最近，一个包括六个危险因素（RF）的预后指标，（不利的东部肿瘤协作组体力状态[ECOG PS]，存在肝转移，对促黄体生成素释放激素[LHRH]激动剂/拮抗剂的短反应，低白蛋白，碱性磷酸酶[ALP]和乳酸脱氢酶[LDH]升高），是从化疗后转移性去势患者的COU-AA-301试验中发现的，在一些实施方案中，使用醋酸阿比特龙治疗耐药前列腺癌（mCRPC）患者。我们的主要目的是评估该模型在接受阿比特龙化疗初治mCRPC患者队列中的作用。方法：我们确定了197名接受阿比特龙化疗初治患者，他们在6个BC癌症机构中心接受阿比特龙治疗，并在所有6个RF上获得完整信息。研究终点为前列腺特异性抗原（PSA）缓解率（RR）、PSA进展时间、治疗时间和总生存期（OS）。采用卡方检验和对数秩检验比较PSA RR和生存结局。多变量考克斯比例风险分析，以确定RF独立相关的OS。结果：患者分为良好（0-1 RF），中间（2-3 RF），和穷人（4-6 RF）预后组（分别为33%，52%和15%）。对于高、中、低风险患者，PSA RR（下降≥ 50%）分别为60%、42%、40%（p=0.05）;至PSA进展的中位时间分别为7.3、5.3、5.0个月（p=0.02）;中位OS分别为29.4、13.8、8.7个月（p = 0.05）。
Introduction: Recently, a prognostic index including six risk factors (RFs) (unfavourable Eastern Cooperative Oncology Group performance status [ECOG PS], presence of liver metastases, short response to luteinizing hormone-releasing hormone [LHRH] agonists/ antagonists, low albumin, increased alkaline phosphatase [ALP] and lactate dehydrogenase [LDH]) was developed from the COU-AA-301 trial in post-chemotherapy metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate. Our primary objective was to evaluate this model in a cohort of chemotherapy-naive mCRPC patients receiving abiraterone.Methods: We identified 197 chemotherapy-naive patients who received abiraterone at six BC Cancer Agency centres and who had complete information on all six RFs. Study endpoints were prostate-specific antigen (PSA) response rate (RR), time to PSA progression, time on treatment, and overall survival (OS). PSA RR and survival outcomes were compared using chi(2) test and log-rank test. Multivariable Cox proportional hazard analysis was performed to identify RFs independently associated with OS.Results: Patients were classified into good (0-1 RFs), intermediate (2-3 RFs), and poor (4-6 RFs) prognostic groups (33%, 52%, and 15%, respectively). For good-, intermediate-, and poor-risk patients, PSA RR (>= 50% decline) was 60% vs. 42% vs. 40% (p=0.05); median time to PSA progression was 7.3 vs. 5.3 vs. 5.0 months (p=0.02); and median OS was 29.4 vs. 13.8 vs. 8.7 months (p