Abstract：
BACKGROUND: A multicenter database was utilized to examine the current treatment landscape and clinical outcomes among patients with metastatic hormone-sensitive prostate cancer (mHSPC) following approval of upfront androgen receptor signaling inhibitors (ARSIs).
METHODS: We retrospectively analyzed patients with mHSPC who commenced treatment between February 2018 and June 2023. The Kaplan-Meier method was used to assess oncological outcomes, including time to castration-resistant prostate cancer (CRPC), progression-free survival 2 (PFS2, duration from initial treatment to tumor progression during second-line treatment), cancer-specific survival (CSS), and overall survival (OS). Cox regression analyses were performed to determine the impact of treatment choices on oncological outcomes. In addition, the incidence rate of adverse events was assessed.
RESULTS: In total, 829 patients were analyzed; 42.5% received ARSIs with androgen deprivation therapy (ADT), 44.0% received combined androgen blockade (CAB), and 13.5% received ADT alone. Kaplan-Meier curves and multivariate Cox regression analyses indicated higher rates of CRPC and shorter PFS2 in patients treated with CAB versus ARSIs with ADT. By contrast, CSS and OS were not significantly different between the ARSI with ADT group and the CAB group. Grades 3-4 adverse events occurred in 1.9% of patients receiving CAB and 6.0% of those receiving ARSIs with ADT.
CONCLUSIONS: Initial treatment with ARSIs in combination with ADT resulted in a longer time to CRPC and longer PFS2 compared to CAB. Although CAB and ADT alone were associated with fewer adverse events, ARSIs with ADT should be considered a first-line treatment option given its superior oncological outcomes.
METHODS: We retrospectively analyzed patients with mHSPC who commenced treatment between February 2018 and June 2023. The Kaplan-Meier method was used to assess oncological outcomes, including time to castration-resistant prostate cancer (CRPC), progression-free survival 2 (PFS2, duration from initial treatment to tumor progression during second-line treatment), cancer-specific survival (CSS), and overall survival (OS). Cox regression analyses were performed to determine the impact of treatment choices on oncological outcomes. In addition, the incidence rate of adverse events was assessed.
RESULTS: In total, 829 patients were analyzed; 42.5% received ARSIs with androgen deprivation therapy (ADT), 44.0% received combined androgen blockade (CAB), and 13.5% received ADT alone. Kaplan-Meier curves and multivariate Cox regression analyses indicated higher rates of CRPC and shorter PFS2 in patients treated with CAB versus ARSIs with ADT. By contrast, CSS and OS were not significantly different between the ARSI with ADT group and the CAB group. Grades 3-4 adverse events occurred in 1.9% of patients receiving CAB and 6.0% of those receiving ARSIs with ADT.
CONCLUSIONS: Initial treatment with ARSIs in combination with ADT resulted in a longer time to CRPC and longer PFS2 compared to CAB. Although CAB and ADT alone were associated with fewer adverse events, ARSIs with ADT should be considered a first-line treatment option given its superior oncological outcomes.
摘要：
背景：在批准前期雄激素受体信号抑制剂（ARSI）后，多中心数据库用于检查转移性激素敏感性前列腺癌（mHSPC）患者的当前治疗状况和临床结果。
方法：我们回顾性分析了2018年2月至2023年6月期间开始治疗的mHSPC患者。Kaplan-Meier方法用于评估肿瘤学结果，包括去势抵抗前列腺癌（CRPC）的时间，无进展生存期2（PFS2，从初始治疗到二线治疗期间肿瘤进展的持续时间），癌症特异性生存率（CSS），总生存率（OS）。进行Cox回归分析以确定治疗选择对肿瘤结果的影响。此外,评估了不良事件的发生率.
结果：总计，对829例患者进行了分析；42.5%的患者接受了ARSI与雄激素剥夺治疗（ADT），44.0%接受联合雄激素阻断（CAB），13.5%单独接受ADT。Kaplan-Meier曲线和多变量Cox回归分析显示，CAB与ARSI患者ADT相比，CRPC发生率较高，PFS2发生率较短。相比之下,CSS和OS在ARSI伴ADT组和CAB组之间没有显着差异。3-4级不良事件发生在1.9%接受CAB的患者和6.0%接受ARSI伴ADT的患者中。
结论：与CAB相比，ARSI联合ADT的初始治疗导致更长的CRPC时间和更长的PFS2。尽管CAB和ADT单独与较少的不良事件相关，具有ADT的ARSI应被视为一线治疗选择，因为其具有优越的肿瘤学结果。
方法：我们回顾性分析了2018年2月至2023年6月期间开始治疗的mHSPC患者。Kaplan-Meier方法用于评估肿瘤学结果，包括去势抵抗前列腺癌（CRPC）的时间，无进展生存期2（PFS2，从初始治疗到二线治疗期间肿瘤进展的持续时间），癌症特异性生存率（CSS），总生存率（OS）。进行Cox回归分析以确定治疗选择对肿瘤结果的影响。此外,评估了不良事件的发生率.
结果：总计，对829例患者进行了分析；42.5%的患者接受了ARSI与雄激素剥夺治疗（ADT），44.0%接受联合雄激素阻断（CAB），13.5%单独接受ADT。Kaplan-Meier曲线和多变量Cox回归分析显示，CAB与ARSI患者ADT相比，CRPC发生率较高，PFS2发生率较短。相比之下,CSS和OS在ARSI伴ADT组和CAB组之间没有显着差异。3-4级不良事件发生在1.9%接受CAB的患者和6.0%接受ARSI伴ADT的患者中。
结论：与CAB相比，ARSI联合ADT的初始治疗导致更长的CRPC时间和更长的PFS2。尽管CAB和ADT单独与较少的不良事件相关，具有ADT的ARSI应被视为一线治疗选择，因为其具有优越的肿瘤学结果。
