Abstract：
OBJECTIVE: Although docetaxel and ARSI are picked up as treatment options against chemo-naïve metastatic CRPC in clinical guidelines for prostate cancer, there is no clear evidence which agent should be introduced as first line treatment. Therefore, we investigated our CRPC cohort treated with docetaxel or ARSI as first-line agent against chemo-naïve CRPC to solve these clinical questions.
METHODS: A total of 345 chemotherapy-naïve CRPC patients introduced to first-line docetaxel or ARSI (abiraterone or enzalutamide) between March 2006 and April 2017 at Jikei University Hospital and its affiliated institutions were included in this study. Propensity score matching method was used to minimize the patients\' background. The outcome measures were PSA response rate, PSA decline ≥ 90%, cancer specific survival (CSS) and overall survival (OS).
RESULTS: PSA decline correlated OS and CSS (p = 0.027, < 0.001, respectively) and median PSA decline rate was 60.4% in docetaxel group and 85.7% in ARSI group (p = 0.0311). Median OS was 33 m (95%CI: 27-53) in docetaxel group and 61 m (95%CI: 47-NA) in ARSI group (p = 0.0246). Median CSS was 34 m (95%CI: 27-53) in docetaxel group and NR (not reached) (95%CI: 61-NA) in ARSI group (p = 0.000133) in propensity score matching cohort. In multivariate analysis, ARSI induction first showed significantly better for OS and CSS (p = 0.0033 and < 0.001, respectively).
CONCLUSIONS: In this study, better survival outcome with ARSI induction first than docetaxel against chemo-naïve CRPC. And the candidates who had survival benefit by induction docetaxel first could not be found in this study.
METHODS: A total of 345 chemotherapy-naïve CRPC patients introduced to first-line docetaxel or ARSI (abiraterone or enzalutamide) between March 2006 and April 2017 at Jikei University Hospital and its affiliated institutions were included in this study. Propensity score matching method was used to minimize the patients\' background. The outcome measures were PSA response rate, PSA decline ≥ 90%, cancer specific survival (CSS) and overall survival (OS).
RESULTS: PSA decline correlated OS and CSS (p = 0.027, < 0.001, respectively) and median PSA decline rate was 60.4% in docetaxel group and 85.7% in ARSI group (p = 0.0311). Median OS was 33 m (95%CI: 27-53) in docetaxel group and 61 m (95%CI: 47-NA) in ARSI group (p = 0.0246). Median CSS was 34 m (95%CI: 27-53) in docetaxel group and NR (not reached) (95%CI: 61-NA) in ARSI group (p = 0.000133) in propensity score matching cohort. In multivariate analysis, ARSI induction first showed significantly better for OS and CSS (p = 0.0033 and < 0.001, respectively).
CONCLUSIONS: In this study, better survival outcome with ARSI induction first than docetaxel against chemo-naïve CRPC. And the candidates who had survival benefit by induction docetaxel first could not be found in this study.
摘要：
目的：尽管多西他赛和ARSI在前列腺癌的临床指南中被认为是对抗化疗初治转移性CRPC的治疗选择，没有明确的证据表明哪种药物应该作为一线治疗。因此,我们调查了使用多西他赛或ARSI作为一线药物治疗的CRPC队列,以解决这些临床问题.
方法：本研究纳入了在2006年3月至2017年4月期间在Jikei大学医院及其附属机构接受一线多西他赛或ARSI（阿比特龙或恩扎鲁他胺）治疗的345例化疗初治CRPC患者。倾向评分匹配方法用于最小化患者的背景。结果测量为PSA反应率，PSA下降≥90%,癌症特异性生存率（CSS）和总生存率（OS）。
结果：PSA下降与OS和CSS相关（分别为p=0.027，<0.001），多西他赛组中位PSA下降率为60.4%，ARSI组为85.7%（p=0.0311）。多西他赛组的中位OS为33m（95CI：27-53），ARSI组为61m（95CI：47-NA）（p=0.0246）。在倾向评分匹配队列中，多西他赛组的CSS中位数为34m（95CI：27-53），ARSI组的NR（未达到）（95CI：61-NA）（p=0.000133）。在多变量分析中，ARSI诱导首先显示OS和CSS的显著更好(分别为p=0.0033和<0.001)。
结论：在这项研究中，ARSI诱导的生存结局优于多西他赛对抗化疗初治CRPC。在这项研究中找不到首先通过诱导多西他赛获得生存益处的候选人。
方法：本研究纳入了在2006年3月至2017年4月期间在Jikei大学医院及其附属机构接受一线多西他赛或ARSI（阿比特龙或恩扎鲁他胺）治疗的345例化疗初治CRPC患者。倾向评分匹配方法用于最小化患者的背景。结果测量为PSA反应率，PSA下降≥90%,癌症特异性生存率（CSS）和总生存率（OS）。
结果：PSA下降与OS和CSS相关（分别为p=0.027，<0.001），多西他赛组中位PSA下降率为60.4%，ARSI组为85.7%（p=0.0311）。多西他赛组的中位OS为33m（95CI：27-53），ARSI组为61m（95CI：47-NA）（p=0.0246）。在倾向评分匹配队列中，多西他赛组的CSS中位数为34m（95CI：27-53），ARSI组的NR（未达到）（95CI：61-NA）（p=0.000133）。在多变量分析中，ARSI诱导首先显示OS和CSS的显著更好(分别为p=0.0033和<0.001)。
结论：在这项研究中，ARSI诱导的生存结局优于多西他赛对抗化疗初治CRPC。在这项研究中找不到首先通过诱导多西他赛获得生存益处的候选人。
