High Serum Alkaline Phosphatase Flare after First-Line Androgen Deprivation Therapy Predicts Poor Prognosis in Metastatic Prostate Cancer Patients Treated with Second-Generation Androgen Receptor Targeted Therapy.
High Serum Alkaline Phosphatase Flare after First-Line Androgen Deprivation Therapy Predicts Poor Prognosis in Metastatic Prostate Cancer Patients Treated with Second-Generation Androgen Receptor Targeted Therapy.
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DOI：
10.1155/2021/5574067
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发表时间：
2021
期刊：
影响因子：
4.2
通讯作者：
Naya Y
中科院分区：
文献类型：
--
作者：
Kojima S;Masuda H;Suyama T;Hou K;Mikami K;Araki K;Naya Y
确定雄激素剥夺治疗（ADT）后碱性磷酸酶（ALP）发作是否与去势抵抗性前列腺癌（CRPC）的治疗反应相关，并预测转移性前列腺癌（PCa）患者的预后。 回顾性研究了2008年至2017年期间诊断为转移性PCa的119例患者。ALP发作率计算为开始ADT后1个月的ALP水平与诊断时ALP水平的比值。研究了ALP发作率与前列腺特异性抗原（PSA）对CRPC治疗（第二代雄激素受体靶向治疗（ART）或多西他赛）的应答、至CRPC的时间和总生存期（OS）的相关性。 ALP发作比率小于1.33的患者至CRPC和OS的时间显著长于比率大于1.33的患者。ART和多西他赛治疗的ALP发作率在PSA缓解方面无差异。ALP发作率较低的第二代ART治疗患者的OS长于ALP发作率较高的患者（p=0.0367）。然而，在接受紫杉醇治疗的患者中，未观察到高ALP发作率和低ALP发作率之间的差异（p=0.8054）。ALP爆发率是OS最重要的预后因素（p < 0.0001）。 一线ADT治疗后ALP发作率较高是转移性PCa的一个重要预后因素，尤其是在接受第二代ART治疗CRPC的患者中。ADT诱导后1个月ALP发作率较高的患者的化疗可能是一个具有临床意义的决定。
To determine whether an alkaline phosphatase (ALP) flare after androgen deprivation therapy (ADT) is associated with the treatment response in castration-resistant prostate cancer (CRPC) and predicts the prognosis of metastatic prostate cancer (PCa) patients. One hundred and nineteen patients diagnosed with metastatic PCa between 2008 and 2017 were retrospectively studied. The ALP flare ratio was calculated as the ratio of ALP levels 1 month after beginning ADT to ALP levels at diagnosis. The association of the ALP flare ratio with the prostate-specific antigen (PSA) response to CRPC treatment (second-generation androgen receptor targeted therapy (ART) or docetaxel), time to CRPC, and overall survival (OS) were investigated. The time to CRPC and OS was significantly longer in patients with an ALP flare ratio less than 1.33 compared to a ratio more than 1.33. No difference in PSA response was seen regarding the ALP flare ratio in both ART and docetaxel treatment. Second-generation ART-treated patients with a low ALP flare ratio showed longer OS than those with a higher ALP flare ratio (p=0.0367). However, no difference was seen between a high and low ALP flare ratio (p=0.8054) in docetaxel-treated patients. The ALP flare ratio was the most significant prognostic factor for OS (p < 0.0001). A higher ALP flare ratio after first-line ADT was a significant prognostic factor in metastatic PCa, especially in patients treated with second-generation ART for CRPC. Chemotherapy for patients with a higher ALP flare ratio 1 month after induction of ADT may be a clinically relevant decision.