现实世界中的生物化学复发后的现实结局在确定治疗后具有短前列腺特异性抗原加倍时间：早期次级治疗的潜在作用
Real-world outcomes following biochemical recurrence after definitive therapy with a short prostate-specific antigen doubling time: potential role of early secondary treatment
影响因子:5.80000
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
摘要
约翰·霍普金斯（Johns Hopkins）的数据充分证明了用延迟的激素治疗管理的生化复发（BCR）的自然史。但是，由于许多患者在转移前接受治疗，因此我们评估了更现代的BCR患者非自传castration敏感性前列腺癌（NMCSPC）的自然历史和作用，并在更现代的BCR患者中，在退伍军人卫生管理中（vha; vha; 01/01/01/01/06/06/06/1/06/22）分为快速（≤9个月），速度较低（> 9至≤15个月）PSADT队列。 PSADT> 15个月的患者被排除在外，即使治疗延迟，也是如此。结果包括BCR，转移，无转移生存期（MFS）和总生存期（OS）之后的第一次抗肿瘤疗法的时间。针对基线人口统计和临床特征进行了调整的COX模型。鉴定出781例BCR患者（502速度； PSADT速度较低279）。快速PSADT与第一次全身性抗塑性疗法的时间较短有关（中间11.4 vs. 28.3个月，调整危险比[95％置信区间] 2.17 [1.83-2.57]），转移（102.4个月，102.4个月，vs.未达到1.79 [1.79 [1.79 [1.33-2.40]），MFS（76.16.16.106 vs.106 vs.106 vs.106 vs.106 vs.106 vs.106 vs.106 vs.106 vs.106 vs.106 vs.106 vs.106 vse。 [1.33-2.24]）和OS（120.5 vs. 140.5个月，1.76 [1.22-2.54]）与PSADT的速度较低。大多数PSADT快速患者在BCR后1年内接受了二级治疗。与延迟治疗的患者的历史数据相比，接受早期治疗治疗的现代患者的结果更好。这些结果是否反映了早期治疗的好处，还是随着时间的推移对前列腺癌预后的总体改善需要进一步研究。
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.