在根治性治疗后生物化学复发伴短前列腺特异性抗原倍增时间的实际临床结果：早期辅助治疗的潜在作用

Real-world outcomes following biochemical recurrence after definitive therapy with a short prostate-specific antigen doubling time: potential role of early secondary treatment

PROSTATE CANCER AND PROSTATIC DISEASES

影响因子:5.8

发表日期:2024 Sep 13

作者: Stephen J Freedland, Wei Gao, Angela Lax, Hongbo Yang, Krishnan Ramaswamy, David Russell, Agnes Hong, Jasmina I Ivanova

DOI: 10.1038/s41391-024-00894-0

摘要

由约翰霍普金斯提供的数据详细记录了采用延迟激素治疗管理的生物化学复发（BCR）的自然史。然而，由于许多患者在转移前接受治疗，我们在一个更现代的非转移性去势敏感性前列腺癌（nmCSPC）患者队列中评估了前列腺特异性抗原倍增时间（PSADT）的自然史及其作用。在退伍军人卫生管理局（VHA；2006年1月1日至2020年6月22日）中，符合条件的nmCSPC和BCR患者被划分为快速（ ≤9个月）和较慢（ >9到 ≤15个月）PSADT组。排除PSADT >15个月的患者，因为即使延迟治疗，预后仍然非常好。主要结局指标包括BCR后首次抗肿瘤治疗的时间、转移情况、无转移生存期（MFS）和总生存期（OS）。采用调整基线人口统计学和临床特征的Cox模型进行分析。总体共识别出781例BCR患者（502例快速组；279例较慢组）。快速PSADT与更短的首次系统性抗肿瘤治疗时间（中位数11.4 vs. 28.3个月，调整风险比[95%置信区间] 2.17 [1.83-2.57]）、转移（102.4个月未达 vs. 未达，1.79 [1.33-2.40]）、无转移生存期（76.1 vs. 106.3个月，1.73 [1.33-2.24]）和总生存期（120.5 vs. 140.5个月，1.76 [1.22-2.54]）均显著较短。大多数快速组患者在BCR后1年内接受二次治疗。采用早期二次治疗的现代患者比历史上延迟治疗的患者预后更佳。是否这些结果反映了早期二次治疗的益处或整体前列腺癌预后随时间改善的趋势，仍需进一步研究。

Abstract

The natural history of biochemical recurrence (BCR) managed with delayed hormonal therapy is well documented by data from Johns Hopkins. However, as many patients receive treatment prior to metastasis, we evaluated the natural history and role of prostate-specific antigen doubling time (PSADT) in a more contemporary cohort of BCR patients with nonmetastatic castration-sensitive prostate cancer (nmCSPC).Patients in the Veterans Health Administration (VHA; 01/01/06 to 06/22/20) with nmCSPC and BCR were divided into rapid ( ≤9 months) and less rapid ( >9 to ≤15 months) PSADT cohorts. Patients with PSADT >15 months were excluded as outcomes, even with delayed treatment, are excellent. Outcomes included time to first antineoplastic therapy after BCR, metastasis, metastasis-free survival (MFS), and overall survival (OS). Cox models adjusted for baseline demographics and clinical characteristics.Overall, 781 patients with BCR were identified (502 rapid; 279 less rapid PSADT). Rapid PSADT was associated with shorter time to first systemic antineoplastic therapy (median 11.4 vs. 28.3 months, adjusted hazard ratio [95% confidence interval] 2.17 [1.83-2.57]), metastasis (102.4 months vs. not reached, 1.79 [1.33-2.40]), MFS (76.1 vs. 106.3 months, 1.73 [1.33-2.24]), and OS (120.5 vs. 140.5 months, 1.76 [1.22-2.54]) versus less rapid PSADT.Most patients with rapid PSADT underwent secondary treatment within 1 year after BCR. More contemporary patients treated with early secondary treatment had better outcomes than historical data from patients who had delayed treatment. Whether these results reflect the benefits of early secondary treatment or overall improvements in prostate cancer outcomes over time requires further study.