Abstract：
BACKGROUND: This study was conducted to better characterize the epidemiology, clinical outcomes, and current treatment patterns of de novo oligometastatic hormone-sensitive prostate cancer (omHSPC) in the United States Veterans Affairs Health Care System.
METHODS: In this observational retrospective cohort study, 400 de novo metastatic hormone-sensitive PC (mHSPC) patients diagnosed from January 2015 to December 2020 (follow-up through December 2021) were randomly selected. omHSPC was defined as five or less total metastases (excluding liver) by conventional imaging. Kaplan-Meier methods estimated overall survival (OS) and castration-resistant prostate cancer (CRPC)-free survival from mHSPC diagnosis date and a log-rank test compared these outcomes by oligometastatic status.
RESULTS: Twenty percent (79 of 400) of de novo mHSPC patients were oligometastatic. Most baseline characteristics were similar by oligometastatic status; however, men with non-omHSPC had higher median prostate-specific antigen at diagnosis (151.7) than omHSPC (44.1). First-line (1L) novel hormonal therapy was similar between groups (20%); 1L chemotherapy was lower in omHSPC (5%) versus non-omHSPC (14%). More omHSPC patients received metastasis-directed therapy/prostate radiation therapy (14%) versus non-omHSPC (2%). Median OS and CRPC-free survival (in months) were higher in omHSPC versus non-omHSPC (44.4; 95% confidence interval [CI], 33.9-not estimated vs. 26.2; 95% CI, 20.5-32.5, p = .0089 and 27.6; 95% CI, 22.1-37.2 vs. 15.3; 95% CI, 12.8-17.9, p = .0049), respectively.
CONCLUSIONS: Approximately 20% of de novo mHSPC were oligometastatic, and OS was significantly longer in omHSPC versus non-omHSPC. Although potentially \"curative\" therapy use was higher in omHSPC versus non-omHSPC, the percentages were still relatively low. Future studies are warranted given potential for prolonged responses with multimodal therapy inclusive of systemic and local therapies.
METHODS: In this observational retrospective cohort study, 400 de novo metastatic hormone-sensitive PC (mHSPC) patients diagnosed from January 2015 to December 2020 (follow-up through December 2021) were randomly selected. omHSPC was defined as five or less total metastases (excluding liver) by conventional imaging. Kaplan-Meier methods estimated overall survival (OS) and castration-resistant prostate cancer (CRPC)-free survival from mHSPC diagnosis date and a log-rank test compared these outcomes by oligometastatic status.
RESULTS: Twenty percent (79 of 400) of de novo mHSPC patients were oligometastatic. Most baseline characteristics were similar by oligometastatic status; however, men with non-omHSPC had higher median prostate-specific antigen at diagnosis (151.7) than omHSPC (44.1). First-line (1L) novel hormonal therapy was similar between groups (20%); 1L chemotherapy was lower in omHSPC (5%) versus non-omHSPC (14%). More omHSPC patients received metastasis-directed therapy/prostate radiation therapy (14%) versus non-omHSPC (2%). Median OS and CRPC-free survival (in months) were higher in omHSPC versus non-omHSPC (44.4; 95% confidence interval [CI], 33.9-not estimated vs. 26.2; 95% CI, 20.5-32.5, p = .0089 and 27.6; 95% CI, 22.1-37.2 vs. 15.3; 95% CI, 12.8-17.9, p = .0049), respectively.
CONCLUSIONS: Approximately 20% of de novo mHSPC were oligometastatic, and OS was significantly longer in omHSPC versus non-omHSPC. Although potentially \"curative\" therapy use was higher in omHSPC versus non-omHSPC, the percentages were still relatively low. Future studies are warranted given potential for prolonged responses with multimodal therapy inclusive of systemic and local therapies.
摘要：
背景：这项研究是为了更好地表征流行病学，临床结果，以及美国退伍军人事务医疗保健系统中从头寡转移激素敏感型前列腺癌（omHSPC）的当前治疗模式。
方法：在这项观察性回顾性队列研究中，随机选择从2015年1月至2020年12月（随访至2021年12月）诊断的400例新生转移激素敏感型PC（mHSPC）患者。通过常规成像将omHSPC定义为五个或更少的总转移(不包括肝脏)。Kaplan-Meier方法估计了从mHSPC诊断日期开始的总生存期（OS）和去势抵抗前列腺癌（CRPC）的无生存期，并进行了对数秩检验，通过寡转移状态比较了这些结果。
结果：20%（400人中有79人）的新生mHSPC患者为寡转移。大多数基线特征与寡转移状态相似；然而，非omHSPC患者在诊断时的前列腺特异性抗原中位数(151.7)高于omHSPC(44.1).一线（1L）新型激素治疗组间相似（20％）；omHSPC（5％）与非omHSPC（14％）的1L化疗较低。更多的omHSPC患者接受转移定向治疗/前列腺放射治疗（14％）与非omHSPC（2％）。omHSPC的中位OS和无CRPC生存期（以月为单位）高于非omHSPC（44.4；95%置信区间[CI]，33.9-未估计与26.2；95%CI，20.5-32.5，p=.0089和27.6；95%CI，22.1-37.2与15.3；95%CI，12.8-17.9，p=0.0049），分别。
结论：大约20％的从头mHSPC是寡转移的，omHSPC的OS明显长于非omHSPC。尽管omHSPC与非omHSPC的潜在“治愈”疗法使用率更高，百分比仍然相对较低。考虑到包括全身和局部治疗在内的多模式治疗的延长反应的潜力，未来的研究是有保证的。
方法：在这项观察性回顾性队列研究中，随机选择从2015年1月至2020年12月（随访至2021年12月）诊断的400例新生转移激素敏感型PC（mHSPC）患者。通过常规成像将omHSPC定义为五个或更少的总转移(不包括肝脏)。Kaplan-Meier方法估计了从mHSPC诊断日期开始的总生存期（OS）和去势抵抗前列腺癌（CRPC）的无生存期，并进行了对数秩检验，通过寡转移状态比较了这些结果。
结果：20%（400人中有79人）的新生mHSPC患者为寡转移。大多数基线特征与寡转移状态相似；然而，非omHSPC患者在诊断时的前列腺特异性抗原中位数(151.7)高于omHSPC(44.1).一线（1L）新型激素治疗组间相似（20％）；omHSPC（5％）与非omHSPC（14％）的1L化疗较低。更多的omHSPC患者接受转移定向治疗/前列腺放射治疗（14％）与非omHSPC（2％）。omHSPC的中位OS和无CRPC生存期（以月为单位）高于非omHSPC（44.4；95%置信区间[CI]，33.9-未估计与26.2；95%CI，20.5-32.5，p=.0089和27.6；95%CI，22.1-37.2与15.3；95%CI，12.8-17.9，p=0.0049），分别。
结论：大约20％的从头mHSPC是寡转移的，omHSPC的OS明显长于非omHSPC。尽管omHSPC与非omHSPC的潜在“治愈”疗法使用率更高，百分比仍然相对较低。考虑到包括全身和局部治疗在内的多模式治疗的延长反应的潜力，未来的研究是有保证的。
