Cytoreductive radiotherapy combined with abiraterone in metastatic castration-resistance prostate cancer: a single center experience.
Cytoreductive radiotherapy combined with abiraterone in metastatic castration-resistance prostate cancer: a single center experience.
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细胞减灭放疗联合阿比特龙治疗转移性去势抵抗性前列腺癌：单中心经验
DOI：
10.1186/s13014-020-01732-y
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发表时间：
2021-01-06
期刊：
影响因子：
--
通讯作者：
He L
中科院分区：
文献类型：
--
作者：
Liu Y;Long W;Zhang Z;Mai L;Huang S;Liu B;Cao W;Wu J;Zhou F;Li Y;He L
背景探讨减瘤放疗（cRT）对接受阿比特龙治疗的转移性去势抵抗性前列腺癌（mCRPC）患者的潜在益处。方法从2014年2月至2019年2月，确定了149例接受阿比特龙治疗的mCRPC患者。阿比特龙失败前接受 cRT 的患者（AbiRT 组）通过一比二的倾向评分与阿比特龙失败前未接受 cRT 的患者（非 AbiRT 组）进行匹配。结果中位随访时间为 23.5 个月。 30 名患者 (20.1%) 属于 AbiRT 组，而 119 名患者 (79.9%) 属于非 AbiRT 组。采用 AbiRT 和非 AbiRT 治疗的患者的 2 年 OS 分别为 89.5% 和 73.5% (P= 0.0003)。在多变量分析中，只有 AbiRT（HR 0.17；95% CI 0.05–0.58；P= 0.004）和预后指数（HR 2.71；95% CI 1.37–5.35；P= 0.004）是显着因素。匹配后，AbiRT 继续与 OS 改善相关（未达到中位 OS 与 44.0 个月，P= 0.009）。亚组分析显示，年龄≤65岁（HR 0.09; 95% CI 0.01–0.65;P= 0.018）、PSA≤ 20 ng/mL（HR 0.29; 95% CI 0.09–0.99;P= 0.048）、未接受过阿比特龙化疗的患者治疗（HR 0.20；95% CI 0.06–0.66；P= 0.008），在采用 COU-AA-301 预后指数的中间预后组中（HR 0.13；95% CI 0.03–0.57；P= 0.007），AbiRT 改善了 OS。 结论 在对阿比特龙耐药之前进行 scRT 可能会改善选定的 mCRPC 患者的生存率：年龄 ≤ 65岁，未接受过化疗，患有 诊断 mCRPC 和中等预后时 PSA 水平相对较低。
BackgroundTo investigate the potential benefit of cytoreductive radiotherapy (cRT) in metastatic castration-resistant prostate cancer (mCRPC) patients receiving abiraterone.MethodsFrom February 2014 to February 2019, 149 mCRPC patients treated with abiraterone were identified. Patients receiving cRT before abiraterone failure (AbiRT group) were matched by one-to-two propensity score to patients without cRT before abiraterone failure (non-AbiRT group).ResultsThe median follow-up was 23.5 months. Thirty patients (20.1%) were in the AbiRT group, whereas 119 patients (79.9%) were in the non-AbiRT group. The 2-year OS of patients managed by AbiRT and non-AbiRT were 89.5% and 73.5%, respectively (P= 0.0003). On multivariate analysis, only AbiRT (HR 0.17; 95% CI 0.05–0.58;P= 0.004) and prognostic index (HR 2.71; 95% CI 1.37–5.35;P= 0.004) were significant factors. After matching, AbiRT continued to be associated with improved OS (median OS not reached vs. 44.0 months,P= 0.009). Subgroup analysis revealed that patients aged ≤ 65 years (HR 0.09; 95% CI 0.01–0.65;P= 0.018), PSA ≤ 20 ng/mL (HR 0.29; 95% CI 0.09–0.99;P= 0.048), chemotherapy-naïve upon abiraterone treatment (HR 0.20; 95% CI 0.06–0.66;P= 0.008) and in intermediate prognosis groups by COU-AA-301 prognostic index (HR 0.13; 95% CI 0.03–0.57;P= 0.007) had improved OS with AbiRT.ConclusionscRT before resistance to abiraterone may improve survival in selected mCRPC patients: age ≤ 65 years old, chemotherapy-naïve, with a relatively low PSA level at the diagnosis of mCRPC and intermediate prognosis.
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