Risk Stratification for the Prediction of Overall Survival Could Assists Treatment Decision Making at the Diagnosis of Castration-Resistant Prostate Cancer - a Multicenter Collaborative Study in Japan.
Risk Stratification for the Prediction of Overall Survival Could Assists Treatment Decision Making at the Diagnosis of Castration-Resistant Prostate Cancer - a Multicenter Collaborative Study in Japan.
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预测总体生存率的风险分层可以帮助诊断去势抵抗性前列腺癌时做出治疗决策 - 日本的一项多中心合作研究。
作者：
Uchimoto T,Komura K;Fukuokaya W;Kimura T;Takahashi K;Fujiwara Y,Matsunaga T;Tsutsumi T;Tsujino T;Taniguchi K;Tanaka T;Uehara H;Ibuki N;Hirano H;Nomi H;Takahara K;Inamoto T;Egawa S;Azuma H.
目的评估根据转移性去势抵抗性前列腺癌（mCRPC）诊断时总生存期（OS）预测因素的新风险分层系统是否可以确定治疗结果并协助治疗决策。患者和方法两个独立的临床患者队列，接受雄激素信号传导抑制剂治疗（ASI：阿比特龙和Enzalutamide）或多西他赛作为mCRPC的一线治疗，用于本研究：派生队列（196例mCRPC患者）和外部验证队列结果OS的三个独立预测因素，包括mCRPC诊断前初始雄激素剥夺治疗的持续时间<12个月，诊断mCRPC时碱性磷酸酶水平>350 U/dL和血红蛋白水平<11 g/dL被定义为风险因素。将具有0、1和多个风险因素的患者分别分配至有利、中等和不良风险组。在推导队列（P< 0.001）和验证队列（P <0.001）中，每个风险组的中位OS值分离良好。在总计407例mCRPC患者中，84例被分配至低风险组，中位OS为12个月。在该组中，观察到多西他赛作为一线治疗（中位数分别为17和12个月）的OS更长的趋势，多西他赛作为一线治疗（中位数分别为17和12个月）。考虑到这些风险定义的便利性，可以鼓励医生在日常实践中考虑这些风险组。
ObjectivesTo assess whether a new risk stratification system according to predictors for overall survival (OS) at the diagnosis of metastatic castration‐resistant prostate cancer (mCRPC) could determine treatment outcomes and assist in treatment decision‐making.Patients and MethodsTwo independent clinical cohorts of patients, treated with androgen signalling inhibitors (ASIs: abiraterone and enzalutamide) or docetaxel as a first‐line treatment for mCRPC, were used in this study: a derivation cohort (196 patients with mCRPC) and an external validation cohort (211 patients with mCRPC).ResultsThree independent predictors for OS, including duration of initial androgen deprivation therapy <12 months before mCRPC diagnosis, alkaline phosphatase level >350 U/dL and haemoglobin level <11 g/dL at the diagnosis of mCRPC, were defined as risk factors. Patients with zero, one and multiple risk factors were assigned to a favourable‐, intermediate‐ and poor‐risk group, respectively. The median OS values in each risk group were well separated in the derivation cohort (P< 0.001) as well as in the validation cohort (P< 0.001). Of a total of 407 patients with mCRPC, 84 were assigned to the poor‐risk group with the median OS of 12 months. In this group, a trend towards longer OS favouring docetaxel compared to ASIs as the first‐line treatment (medians of 17 and 12 months, respectively) was observed.ConclusionThe new risk group stratification system could predict patient survival at the diagnosis of mCRPC. Given the convenience of these risk definitions, physicians may be encouraged to consider these risk groups in daily practice.