目的:我们旨在探讨神经内分泌分化(NED)在接受阿比特龙或多西他赛一线治疗的转移性去势抵抗性前列腺癌(mCRPC)患者中的预测价值。
方法:我们回顾性分析了262例接受阿比特龙或多西他赛一线mCRPC治疗的mCRPC患者的数据。在mCRPC时通过免疫组织化学染色使用前列腺活检样品评估NED。使用Kaplan-Meier曲线和Cox回归来评估NED与治疗结果之间的关联,包括PSA无进展生存期(PSA-PFS)。放射学无进展生存期(rPFS),总生存率(OS)。
结果:NED在100/262(38.2%)mCRPC患者中得到证实,76/100(76.0%)和24/100(24.0%)男性的NED<10%和NED≥10%,分别。203/262(77.5%)和59/262(22.5%)患者接受阿比特龙和多西他赛,分别。在阿比特龙治疗中,NED与PSA-PFS中位数显著较短(mPSA-PFS,7.5vs.10.3-Mo,P<0.001),中位数rPFS(mrPFS,15.9vs.19.5-Mo,P=0.010),和中位数OS(mOS,23.2vs.34.3-Mo,P=0.014))。同样,对于接受多西他赛的mCRPC患者,NED阳性检测也预测mPSA-PFS较短(3.8vs.5.9-Mo,P=0.052),mrPFS(8.4vs.20.4-Mo,P=0.016)和mOS(13.6vs.29.0-Mo,P=0.033)。NED的不良预后特征在大多数亚组中是一致的。此外,随着两种疗法中NED比例的增加,患者的生存结局恶化。在倾向得分匹配后,NED阳性患者在阿比特龙和多西他赛治疗中的预后相当。
结论:对于接受阿比特龙或多西他赛的mCRPC患者,NED及其比例是关键的预测因素。mCRPC的NED检测可能有助于预测患者的预后并优化治疗决策。
OBJECTIVE: We aim to explore the predictive value of neuroendocrine differentiation (NED) in patients with metastatic castration-resistant prostate cancer (mCRPC) receiving abiraterone or docetaxel as first-line therapy.
METHODS: We retrospectively analyzed data of 262 mCRPC patients receiving abiraterone or docetaxel as first-line mCRPC treatment. NED was evaluated using prostate biopsy samples at the time of mCRPC by immunohistochemical staining. Kaplan-Meier curves and Cox regression were used to assess the association between NED and treatment outcomes including PSA progression-free survival (PSA-PFS), radiographic progression-free survival (rPFS), and overall survival (OS).
RESULTS: NED was confirmed in 100/262 (38.2%) mCRPC patients, with 76/100 (76.0%) and 24/100 (24.0%) men harboring NED < 10% and NED ≥ 10%, respectively. 203/262 (77.5%) and 59/262 (22.5%) patients received abiraterone and docetaxel, respectively. In abiraterone treatment, NED was associated with a significantly shorter median PSA-PFS (mPSA-PFS, 7.5 vs. 10.3-Mo, P < 0.001), median rPFS (mrPFS, 15.9 vs. 19.5-Mo, P = 0.010), and median OS (mOS, 23.2 vs. 34.3-Mo, P = 0.014)). Likewise, for mCRPC patients receiving docetaxel, the positive detection of NED also predicted shorter mPSA-PFS (3.8 vs. 5.9-Mo, P = 0.052), mrPFS (8.4 vs. 20.4-Mo, P = 0.016) and mOS (13.6 vs. 29.0-Mo, P = 0.033). The adverse prognostic trait of NED is consistent in most subgroups. Additionally, patients\' survival outcomes deteriorated as the NED proportion grew in both therapies. After propensity score matching, NED-positive patients showed comparable prognosis in abiraterone and docetaxel therapy.
CONCLUSIONS: For mCRPC patients receiving abiraterone or docetaxel, NED and its proportion were critical predictive factors. NED detection at mCRPC might aid in predicting patients\' outcomes and optimizing treatment decisions.