Chromogranin A and neurone-specific enolase serum levels as predictors of treatment outcome in patients with metastatic castration-resistant prostate cancer undergoing abiraterone therapy
Chromogranin A and neurone-specific enolase serum levels as predictors of treatment outcome in patients with metastatic castration-resistant prostate cancer undergoing abiraterone therapy
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DOI：
10.1111/bju.13493
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发表时间：
2017-01-01
影响因子：
4.5
通讯作者：
Retz, Margitta
中科院分区：
文献类型：
--
作者：
Heck, Matthias M.;Thaler, Markus A.;Retz, Margitta
目的确定升高的神经内分泌血清标志物对转移性去势抵抗性前列腺癌（mCRPC）患者接受阿比特龙治疗后化疗setting.Patients和MethodChromogranin A（CGa）和神经元特异性烯醇化酶（NSE）的治疗结果的影响，从45例mCRPC患者阿比特龙治疗前抽取血清进行测定。结果的措施是总生存期（OS），前列腺特异性抗原（PSA）反应定义的PSA水平下降>= 50%，PSA无进展生存期（PSA-PFS），和临床或放射学PFS。根据无、一种或两种神经内分泌标志物的升高，分别将患者分为低风险组（9例）、中风险组（18例）或高风险组（18例）。风险组与中位OS降低（中位OS未达到vs 15.3 vs 6.6个月; P < 0.001）、中位临床或影像学PFS降低（8.3 vs 4.4 vs 2.7个月; P = 0.001）和中位PSA-PFS降低（12.0 vs 3.2 vs 2.7个月; P = 0.012）相关。在多变量考克斯回归分析中，CGa和NSE的组合（>= 1个标志物阳性vs两个标志物阴性）仍然是OS、临床或放射学PFS和PSA-PFS的显著预测因子。我们没有观察到与PSA反应的相关性（63% vs 35% vs 31%; P = 0.2）。结论嗜铬粒蛋白A和NSE不能预测阿比特龙治疗的mCRPC患者的PSA反应。然而，我们观察到与较短的PSA-PFS、临床或影像学PFS和OS相关。这可能是由于阿比特龙治疗下与神经内分泌分化相关的耐药风险升高。
ObjectiveTo determine the impact of elevated neuroendocrine serum markers on treatment outcome in patients with metastatic castration-resistant prostate cancer (mCRPC) undergoing treatment with abiraterone in a post-chemotherapy setting.Patients and MethodChromogranin A (CGa) and neurone-specific enolase (NSE) were determined in serum drawn before treatment with abiraterone from 45 patients with mCRPC. Outcome measures were overall survival (OS), prostate-specific antigen (PSA) response defined by a PSA level decline of >= 50%, PSA progression-free survival (PSA-PFS), and clinical or radiographic PFS.ResultsThe CGa and NSE serum levels did not correlate (P = 0.6). Patients were stratified in to low-(nine patients), intermediate-(18) or high-risk (18) groups according to elevation of none, one, or both neuroendocrine markers, respectively. The risk groups correlated with decreasing median OS (median OS not reached vs 15.3 vs 6.6 months; P < 0.001), decreasing median clinical or radiographic PFS (8.3 vs 4.4 vs 2.7 months; P = 0.001) and decreasing median PSA-PFS (12.0 vs 3.2 vs 2.7 months; P = 0.012). In multivariate Cox regression analysis the combination of CGa and NSE (>= 1 marker positive vs both markers negative) remained significant predictors of OS, clinical or radiographic PFS, and PSA-PFS. We did not observe a correlation with PSA response (63% vs 35% vs 31%; P = 0.2).ConclusionChromogranin A and NSE did not predict PSA response in patients with mCRPC treated with abiraterone. However, we observed a correlation with shorter PSA-PFS, clinical or radiographic PFS, and OS. This might be due to an elevated risk of developing resistance under abiraterone treatment related to neuroendocrine differentiation.