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How many bone metastases may be defined as high-volume metastatic prostate cancer in Asians: A retrospective multicenter cohort study.

亚洲人有多少骨转移可能被定义为高容量转移性前列腺癌: 一项回顾性多中心队列研究。

  • 影响因子:3.24
  • DOI:10.1002/pros.23958
  • 作者列表:"Yamada Y","Sakamoto S","Rii J","Yamamoto S","Kamada S","Imamura Y","Nakamura K","Komiya A","Nakatsu H","Ichikawa T
  • 发表时间:2020-04-01
Abstract

BACKGROUND:Recent landmark randomized trials (CHAARTED and LATITUDE studies) have highlighted potent upfront therapy for "high-volume" and "high-risk" metastatic castration-naïve prostate cancer (mCNPC). However, treatment response shows racial differences. We aimed to propose a novel definition for "high-volume" prostate cancer in Asians. METHODS:We retrospectively pursued 426 patients with de novo mCNPC from multiple institutions between 1999 and 2017. All patients received androgen deprivation therapy alone as initial treatment. We evaluated the number of bone metastases at diagnosis to clarify the clinical significance for progression-free survival and overall survival (OS). Statistical analyses were conducted using the Mann-Whitney U test, Cox proportional hazard models, and Kaplan-Meier methods. RESULTS:Median age and prostate-specific antigen level were 73 years and 266.2 ng/ml, respectively. Median OS was 55.5 months in patients who met the CHAARTED high criteria (vs 33.1 months in the trial). We evaluated 5 thresholds in the number of bone metastases (≥4, ≥6, ≥11, ≥16, and ≥21) to investigate the prognostic values. Patients with ≥11 bone metastases showed the highest HR for OS (2.766). Patients with 11 to 20 bone metastases had a significantly shorter OS than those with ≤10 metastases (P = .0001). We, therefore, proposed modified CHAARTED and LATITUDE high criteria (extending bone metastases ≥11). In multivariate analysis, the modified criteria were the only independent prognostic factors for OS (P = .0272 and P = .042, respectively). Conversely, no significant differences in OS were seen between patients with 1 to 3 bone metastases and 4 to 10 (P = .7513). CONCLUSION:Our exploratory study suggested ≥11 bone metastases as a suitable definition for "high-volume" prostate cancer in Asians. A larger, prospective study is warranted to verify our findings.

摘要

背景: 最近具有里程碑意义的随机试验 (CHAARTED和LATITUDE研究) 强调了 “高容量” 和 “高风险” 转移性去势初治前列腺癌 (mscnpc) 的有效前期治疗。然而,治疗反应显示出种族差异。我们旨在为亚洲人的 “高容量” 前列腺癌提出一个新的定义。 方法: 我们回顾性调查了 1999 年至 426 年间来自多个机构的 2017 例de novo mCNPC患者。所有患者均接受单纯雄激素阻断治疗作为初始治疗。我们评估了诊断时骨转移的数量,以阐明无进展生存期和总生存期 (OS) 的临床意义。使用Mann-Whitney U检验、Cox比例风险模型和Kaplan-Meier方法进行统计分析。 结果: 中位年龄和前列腺特异性抗原水平分别为 73 岁和 266.2 ng/ml。符合CHAARTED高标准的患者的中位OS为 55.5 个月 (试验中为 33.1 个月)。我们评估了骨转移数量的 5 个阈值 (≥ 4 、 ≥ 6 、 ≥ 11 、 ≥ 16 和 ≥ 21),以研究预后价值。≥ 11 例骨转移患者OS的HR最高 (2.766)。11 ~ 20 个骨转移患者的OS明显短于 ≤ 10 个骨转移患者 (p =.0001)。因此,我们提出了改良的CHAARTED和LATITUDE高标准 (延长骨转移 ≥ 11)。在多变量分析中,修改后的标准是OS的唯一独立预后因素 (分别为p = 0272 和p =.042)。相反,1 ~ 3 个骨转移和 4 ~ 10 个骨转移患者的OS无显著差异 (p =.7513)。 结论: 我们的探索性研究提示 ≥ 11 骨转移是亚洲人 “高容量” 前列腺癌的合适定义。需要一项更大的前瞻性研究来验证我们的研究结果。

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

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