Patterns of Recurrence and Modes of Progression After Metastasis-Directed Therapy in Oligometastatic Castration-Sensitive Prostate Cancer.
Patterns of Recurrence and Modes of Progression After Metastasis-Directed Therapy in Oligometastatic Castration-Sensitive Prostate Cancer.
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转移指导治疗的寡聚化cast割敏感的前列腺癌的复发模式和进展模式。
DOI：
10.1016/j.ijrobp.2020.08.030
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发表时间：
2021-02-01
期刊：
影响因子：
--
通讯作者：
Tran PT
中科院分区：
文献类型：
--
作者：
Deek MP;Taparra K;Dao D;Chan L;Phillips R;Gao RW;Kwon ED;Deville C;Song DY;Greco S;Carducci MA;Eisenberger M;DeWeese TL;Denmeade S;Pienta K;Paller CJ;Antonarakis ES;Olivier KR;Park SS;Stish BJ;Tran PT
转移导向治疗(MDT)因其延长无进展生存期(PFS)和无雄激素剥夺生存期而越来越多地应用于去势敏感型少转移前列腺癌。在这里，我们使用SABR描述MDT后复发的模式和确定进展模式。从多机构数据库中回顾鉴定了258例去势敏感型少转移前列腺癌患者(分期时为≤5病变)。报告了复发的描述性模式和进展模式。其他结果包括前列腺特异性抗原(PSA)复发的中位时间、下一次干预的时间、无远处转移生存率、总生存率和生化PFS(BPFS)。采用Kaplan-Meier方法进行生存分析，并进行多因素分析。中位随访期为25.2个月，50.4%的患者同时接受雄激素剥夺治疗。中位PSA复发时间为15.7个月，下一次介入治疗时间为28.6个月，无远处转移生存期为19.1个月，bPFS为16.1个月。两年总生存率为96.8%。在多变量分析中，与bPFS相关的因素包括年龄(危险比，1.03；P=0.04)、确诊时的N1疾病(HR，2.00；P=0.02)、确诊时的M1疾病(HR，0.44；P=0.01)、确诊时的首次PSA(HR，1.002；P=.001)、雄激素剥夺治疗的使用(HR，0.41P<；.001)、SABR前的PSA(HR，1.02；P=.01)，并使用增强成像进行分期(HR，2.81；P=.001)。进展模式有利于复发的骨成分；在最初仅接受骨损伤治疗的患者中，绝大多数(86.5%)经历了包括骨部位在内的复发。最初单独接受结节部位治疗的患者倾向于仅在一个结节复发(64.5%)；然而，也有相当少数的患者在进展中有骨性复发(32.3%)。进展模式：I类(长期控制组[治疗18个月后无复发])占40.9%，II类(寡聚进展组[≥3个复发病灶])占36%(包括7.9%的≤复发但无转移的患者)，III类(多进展组[3个病灶])占23.1%。MDT后，大多数患者有长期控制或少进展(I级或II级)。复发倾向于发生在骨性部位。这些发现，如果得到证实，将对MDT和临床试验设计的未来整合产生影响。
Metastasis-directed therapy (MDT) is increasingly used in castration-sensitive oligometastatic prostate cancer because it prolongs progression-free survival (PFS) and androgen deprivation free survival. Here we describe patterns of recurrence and identify modes of progression after MDT using SABR. Two hundred fifty-eight patients with castration-sensitive oligometastatic prostate cancer (≤5 lesions at staging) were retrospectively identified from a multi-institutional database. Descriptive patterns of recurrence and modes of progression were reported. Other outcomes including median time to prostate-specific antigen (PSA) recurrence, time to next intervention, distant metastasis–free survival, overall survival, and biochemical PFS (bPFS) were reported. Survival analysis was performed using the Kaplan-Meier method, and multivariable analysis was performed. Median follow-up was 25.2 months, and 50.4% of patients received concurrent androgen deprivation. Median time to PSA recurrence was 15.7 months, time to next intervention was 28.6 months, distant metastasis–free survival was 19.1 months, and bPFS was 16.1 months. Two-year overall survival was 96.8%. On multivariable analysis, factors associated with bPFS included age (hazard ratio [HR], 1.03; P = .04), N1 disease at diagnosis (HR, 2.00; P = .02), M1 disease at diagnosis (HR, 0.44; P = .01), initial PSA at diagnosis (HR, 1.002; P = <.001), use of androgen deprivation therapy (HR, 0.41; P < .001), pre-SABR PSA (HR, 1.02; P = .01), and use of enhanced imaging for staging (HR, 2.81; P = .001). Patterns of progression favored an osseous component at recurrence; in patients initially treated to a bone lesion alone, the vast majority (86.5%) experienced a recurrence that included an osseous site. Patients treated initially to a nodal site alone tended to recur in a node only (64.5%); however, there was also a significant minority with an osseous component of recurrence at progression (32.3%). Modes of progressors were class I (patients with long term control [no recurrence ≥18 months after therapy]) occurring in 40.9%, class II (oligoprogressors [≤3 lesions at recurrence]) occurring in 36% (including 7.9% of patients with PSA recurrence but no metastatic disease), and class III (polyprogressors [>3 lesions]) occurring in 23.1% of patients. After MDT, the majority of patients have long-term control or oligoprogression (class I or II). Recurrence tended to occur in osseous sites. These findings, if validated, have implications for future integration of MDT and clinical trial design.
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影响因子：
3.8
作者：
Hasan, Hamza;Deek, Matthew P.;Tran, Phuoc T.
通讯作者：
Tran, Phuoc T.
影响因子：
45.3
作者：
Kyriakopoulos, Christos E.;Chen, Yu-Hui;Sweeney, Christopher J.
通讯作者：
Sweeney, Christopher J.
DOI：
10.1186/1748-717x-9-135
发表时间：
2014-06-12
期刊：
Radiation oncology (London, England)
影响因子：
--
作者：
Decaestecker K;De Meerleer G;Lambert B;Delrue L;Fonteyne V;Claeys T;De Vos F;Huysse W;Hautekiet A;Maes G;Ost P
通讯作者：
Ost P
影响因子：
51.1
作者：
Gomez, Daniel R.;Blumenschein, George R., Jr.;Lee, J. Jack;Hernandez, Mike;Ye, Rong;Camidge, D. Ross;Doebele, Robert C.;Skoulidis, Ferdinandos;Gaspar, Laurie E.;Gibbons, Don L.;Karam, Jose A.;Kavanagh, Brian D.;Tang, Chad;Komaki, Ritsuko;Louie, Alexander V.;Palma, David A.;Tsao, Anne S.;Sepesi, Boris;William, William N.;Zhang, Jianjun;Shi, Qiuling;Wang, Xin Shelley;Swisher, Stephen G.;Heymach, John V.
通讯作者：
Heymach, John V.
影响因子：
3.1
作者：
Henkenberens, Christoph;von Klot, Christoph A.;Derlin, Thorsten
通讯作者：
Derlin, Thorsten