Aspirin improves outcome in high risk prostate cancer patients treated with radiation therapy
Aspirin improves outcome in high risk prostate cancer patients treated with radiation therapy
复制标题
DOI：
10.4161/cbt.28554
复制
发表时间：
2014-06-01
影响因子：
3.6
通讯作者：
Kim, D. W. Nathan
中科院分区：
文献类型：
--
作者：
Jacobs, Corbin D.;Chun, Stephen G.;Kim, D. W. Nathan
目的：高危前列腺癌 (PC) 由于对传统治疗（包括前列腺切除术、放射治疗和激素治疗）产生耐药性而导致预后不佳。先前的研究表明，抗凝剂 (AC) 的使用可以改善 PC 患者的治疗结果。我们假设，当高危 PC 患者接受放疗时，AC 疗法可避免生化衰竭 (FFBF) 并带来总生存 (OS) 益处。 材料和方法：对 2005 年至 2008 年在 UT Southwestern 接受放疗的 74 名高危 PC 患者进行了分析。在这些患者中，43 例接受 AC 治疗，包括阿司匹林 (95.6%)、氯吡格雷 (17.8%)、华法林 (20%) 和多种 AC 治疗 (31.1%)。分析了 AC 使用与 FFBF、OS、远处转移和毒性之间的关联。结果：所有患者的中位随访时间为 56.6 个月。与未服用 AC 的患者相比，服用任何 AC 的患者 5 年时的 FFBF 改善为 80% 与 62% (P = 0.003)，而服用阿司匹林的 FFBF 为 84% 与 65% (P = 0.008)。使用阿司匹林还与 5 年远处转移率降低相关（12.2% vs. 26.7%，P = 0.039）。在对组织学 Gleason 评分 (GS) 9-10 的患者进行子集分析时，阿司匹林改善了 5 年 OS（88% vs. 37%，P = 0.032），这在多变量分析中仍然显着（P < 0.05）。结论：AC 使用与高风险 PC 的 FFBF 获益相关，这转化为 GS 9-10 的最高风险 PC 患者的 OS 获益，这些患者最有可能经历 PC 造成的死亡。这一假设生成结果表明，交流电的使用可能是增强当前治疗的机会。
Purpose: High-risk prostate cancer (PC) has poor outcomes due to therapeutic resistance to conventional treatments, which include prostatectomy, radiation, and hormone therapy. Previous studies suggest that anticoagulant (AC) use may improve treatment outcomes in PC patients. We hypothesized that AC therapy confers a freedom from biochemical failure (FFBF) and overall survival (OS) benefit when administered with radiotherapy in patients with high-risk PC.Materials and Methods: Analysis was performed on 74 high-risk PC patients who were treated with radiotherapy from 2005 to 2008 at UT Southwestern. Of these patients, 43 were on AC including aspirin (95.6%), clopidogrel (17.8%), warfarin (20%), and multiple ACs (31.1%). Associations between AC use and FFBF, OS, distant metastasis, and toxicity were analyzed.Results: Median follow-up was 56.6 mo for all patients. For patients taking any AC compared with no AC, there was improved FFBF at 5 years of 80% vs. 62% (P = 0.003), and for aspirin the FFBF was 84% vs. 65% (P = 0.008). Aspirin use was also associated with reduced rates of distant metastases at 5 years (12.2% vs. 26.7%, P = 0.039). On subset analysis of patients with Gleason score (GS) 9-10 histology, aspirin resulted in improved 5-year OS (88% vs. 37%, P = 0.032), which remained significant on multivariable analysis (P < 0.05).Conclusions: AC use was associated with a FFBF benefit in high-risk PC which translated into an OS benefit in the highest risk PC patients with GS 9-10, who are most likely to experience mortality from PC. This hypothesis-generating result suggests AC use may represent an opportunity to augment current therapy.