阿比罗酮或enzalutamide用于转移性castration前列腺癌患者

建议将醋酸盐和乙酸酯作为转移性cast割前列腺癌（MCRPC）的首选治疗方法，但由于缺乏头对头临床试验，其相对功效的差异尚不清楚。需要明确的指导来做出知情的MCRPC治疗选择。要比较接受阿比特酮乙酸酯或乙酸酯治疗的MCRPC患者的临床结局。这项回顾性多中心同伴研究包括美国MCRPC患者在美国的MCRPC患者中，在美国的ABIRENES ABIRENES ARBIRERANE 30. ABERONE ACTRANE ACTARESIDES ACTRATICE ACTERIDES ACTERINE in CANIRETAMS AINTAMIDAM中进行了MCRPC患者， 2022.Abiraterone acetate or enzalutamide.The study used inverse probability of treatment weighting to balance baseline characteristics between patients initiating abiraterone acetate or enzalutamide and evaluated restricted mean survival time (RMST) differences in overall survival (OS), prostate cancer-specific survival (PCS), time to next treatment switching or death (TTS), and time to prostate-specific antigen （PSA）在治疗开始后不同时间点的反应（TTR）。该研究包括5779例患者（中位年龄，74.42岁[IQR，68.94-82.14岁））。中位随访时间在38到60个月之间。启动乙酰胺的患者平均具有比乙酸阿比罗酮的OS更长的OS，RMST为24.29个月（95％CI，23.58-24.99个月）和23.38个月（分别为95％CI，22.85-23.92个月），在0.90％的RMST（95％CI）中，差异为0.95％CI，0.02.02.02.02.02.0.0.90.0.0 news 0.0.0.02.0.0.0.0 nder。同样，在启动恩扎拉胺的患者中，TTS和TTR得到了改善，TTS和3.57个月（95％CI，1.76-5.38个月）的时间为4年，为4年的1.95个月（95％CI，0.92-2.99个月）。对于PC，2年的RMST为0.48个月（95％CI，0.01-0.95个月）。 An examination of subgroups identified that enzalutamide initiation was associated with longer RMST in OS among patients without prior docetaxel treatment (1.14 months; 95% CI, 0.19-2.10 months) and in those with PSA doubling time of 3 months or longer (2.23 months; 95% CI, 0.81-3.66 months) but not among patients with prior docetaxel (-0.25 months; 95% CI, -2.59至2.09个月）或PSA的两倍时间少于3个月（0.05个月； 95％CI，-1.05至1.15个月）。在这项对MCRPC患者的队列研究中，Enzalutamide的患者的启动与OS，PCS，TTS和TTS相比，eNzalutamide的启动与较小但稳定的改善相关，并与Abiratie acttre obiratie acttr相比。在短期结局（包括TTS和TTR）以及没有事先多西他赛的患者亚组或PSA倍增时间中，这些改进在包括TTS和TTR的短期结局中更为突出。

Abiraterone acetate and enzalutamide are recommended as preferred treatments for metastatic castration-resistant prostate cancer (mCRPC), but differences in their relative efficacy are unclear due to a lack of head-to-head clinical trials. Clear guidance is needed for making informed mCRPC therapeutic choices.To compare clinical outcomes in patients with mCRPC treated with abiraterone acetate or enzalutamide.This retrospective, multicenter cohort study included patients with mCRPC in the US Department of Veterans Affairs health care system who initiated treatment with abiraterone acetate or enzalutamide between January 1, 2014, and October 30, 2022.Abiraterone acetate or enzalutamide.The study used inverse probability of treatment weighting to balance baseline characteristics between patients initiating abiraterone acetate or enzalutamide and evaluated restricted mean survival time (RMST) differences in overall survival (OS), prostate cancer-specific survival (PCS), time to next treatment switching or death (TTS), and time to prostate-specific antigen (PSA) response (TTR) at different time points after treatment initiation.The study included 5779 patients (median age, 74.42 years [IQR, 68.94-82.14 years]). Median follow-up was between 38 and 60 months. Patients initiating enzalutamide on average had longer OS than those initiating abiraterone acetate, with RMSTs of 24.29 months (95% CI, 23.58-24.99 months) and 23.38 months (95% CI, 22.85-23.92 months), respectively, and a difference in RMST of 0.90 months (95% CI, 0.02-1.79 months) at 4 years. Similarly, TTS and TTR were improved in patients initiating enzalutamide, with an RMST at 4 years of 1.95 months (95% CI, 0.92-2.99 months) longer for TTS and 3.57 months (95% CI, 1.76-5.38 months) shorter for TTR. For PCS, the RMST at 2 years was 0.48 months (95% CI, 0.01-0.95 months) longer. An examination of subgroups identified that enzalutamide initiation was associated with longer RMST in OS among patients without prior docetaxel treatment (1.14 months; 95% CI, 0.19-2.10 months) and in those with PSA doubling time of 3 months or longer (2.23 months; 95% CI, 0.81-3.66 months) but not among patients with prior docetaxel (-0.25 months; 95% CI, -2.59 to 2.09 months) or with PSA doubling time of less than 3 months (0.05 months; 95% CI, -1.05 to 1.15 months).In this cohort study of patients with mCRPC, initiation of enzalutamide was associated with small but statistically significant improvements in OS, PCS, TTS, and TTR compared with initiation of abiraterone acetate. The improvements were more prominent in short-term outcomes, including TTS and TTR, and in patient subgroups without prior docetaxel or with PSA doubling time longer than 3 months.