Abstract：
BACKGROUND: Optimal drug selection for metastatic hormone-sensitive prostate cancer (mHSPC) remains unclear. We therefore assessed the clinical outcomes of mHSPC treated with new-generation androgen receptor pathway inhibitors (ARSIs) and identified risk factors associated with the prognosis of mHSPC.
METHODS: We retrospectively reviewed 324 patients with mHSPC who were treated with ARSIs, including abiraterone acetate, enzalutamide, and apalutamide, between January 2018 and December 2022. In addition to assessing the prostate-specific antigen (PSA) response and overall survival (OS) during ARSI treatment, we investigated several potential risk factors for a poor OS in patients with mHSPC.
RESULTS: Patients with a ≥ 90% PSA reduction (hazard ratio [HR]: 0.24, 95% confidence interval [CI], 0.10-0.58; P = .002) and those whose PSA declined to ≤ 0.2 ng/mL (HR: 0.22, 95% CI, 0.08-0.63; P = .005) showed significantly better OS than other patients. Gleason grade group 5 (GG5), presence of liver metastasis, and an LDH ≥ 250 U/L were identified as prognostic factors significantly associated with a poor OS, with HRs of 2.31 (95% CI, 1.02-5.20; P = .044), 7.87 (95% CI, 2.61-23.8; P < .001) and 3.21 (95% CI, 1.43-7.23; P = .005).
CONCLUSIONS: We identified GG5, the presence of liver metastasis, and elevated LDH at the diagnosis as significant factors predicting the OS of mHSPC, but the choice of ARSIs did not affect the prognosis. The potential prognostic impact of these markers requires further investigation.
METHODS: We retrospectively reviewed 324 patients with mHSPC who were treated with ARSIs, including abiraterone acetate, enzalutamide, and apalutamide, between January 2018 and December 2022. In addition to assessing the prostate-specific antigen (PSA) response and overall survival (OS) during ARSI treatment, we investigated several potential risk factors for a poor OS in patients with mHSPC.
RESULTS: Patients with a ≥ 90% PSA reduction (hazard ratio [HR]: 0.24, 95% confidence interval [CI], 0.10-0.58; P = .002) and those whose PSA declined to ≤ 0.2 ng/mL (HR: 0.22, 95% CI, 0.08-0.63; P = .005) showed significantly better OS than other patients. Gleason grade group 5 (GG5), presence of liver metastasis, and an LDH ≥ 250 U/L were identified as prognostic factors significantly associated with a poor OS, with HRs of 2.31 (95% CI, 1.02-5.20; P = .044), 7.87 (95% CI, 2.61-23.8; P < .001) and 3.21 (95% CI, 1.43-7.23; P = .005).
CONCLUSIONS: We identified GG5, the presence of liver metastasis, and elevated LDH at the diagnosis as significant factors predicting the OS of mHSPC, but the choice of ARSIs did not affect the prognosis. The potential prognostic impact of these markers requires further investigation.
摘要：
背景：转移激素敏感型前列腺癌（mHSPC）的最佳药物选择尚不清楚。因此，我们评估了新一代雄激素受体途径抑制剂（ARSI）治疗mHSPC的临床结果，并确定了与mHSPC预后相关的危险因素。
方法：我们回顾性分析了324例接受ARSI治疗的mHSPC患者，包括醋酸阿比特龙,恩扎鲁他胺,和阿帕鲁胺,2018年1月至2022年12月。除了评估ARSI治疗期间的前列腺特异性抗原（PSA）反应和总生存期（OS），我们调查了mHSPC患者OS差的几个潜在危险因素.
结果：PSA降低≥90％的患者（风险比[HR]：0.24，95％置信区间[CI]，0.10-0.58；P=.002）和PSA下降至≤0.2ng/mL（HR：0.22，95％CI，0.08-0.63；P=.005）的患者的OS明显优于其他患者。格里森等级第5组(GG5)，肝转移的存在，LDH≥250U/L被确定为与不良OS显著相关的预后因素，HR为2.31（95%CI，1.02-5.20；P=0.044），7.87（95%CI，2.61-23.8；P<.001）和3.21（95%CI，1.43-7.23；P=.005）。
结论：我们确定了GG5，即肝转移的存在，诊断时LDH升高是预测mHSPCOS的重要因素，但ARSI的选择并不影响预后。这些标志物的潜在预后影响需要进一步研究。
方法：我们回顾性分析了324例接受ARSI治疗的mHSPC患者，包括醋酸阿比特龙,恩扎鲁他胺,和阿帕鲁胺,2018年1月至2022年12月。除了评估ARSI治疗期间的前列腺特异性抗原（PSA）反应和总生存期（OS），我们调查了mHSPC患者OS差的几个潜在危险因素.
结果：PSA降低≥90％的患者（风险比[HR]：0.24，95％置信区间[CI]，0.10-0.58；P=.002）和PSA下降至≤0.2ng/mL（HR：0.22，95％CI，0.08-0.63；P=.005）的患者的OS明显优于其他患者。格里森等级第5组(GG5)，肝转移的存在，LDH≥250U/L被确定为与不良OS显著相关的预后因素，HR为2.31（95%CI，1.02-5.20；P=0.044），7.87（95%CI，2.61-23.8；P<.001）和3.21（95%CI，1.43-7.23；P=.005）。
结论：我们确定了GG5，即肝转移的存在，诊断时LDH升高是预测mHSPCOS的重要因素，但ARSI的选择并不影响预后。这些标志物的潜在预后影响需要进一步研究。
