背景:在过去的几十年中,针对转移性激素敏感性(mHSPC)和去势抵抗性前列腺癌(mCRPC)的全身疗法的前景得到了广泛改善,从而显着延长了总生存期。然而,III期试验的亚组分析提示,老年人的总体生存结局可能不同.
方法:我们依靠我们的机构转移性前列腺癌数据库来鉴定mHSPC和随后的mCRPC患者。在转移发生时,根据70-74岁年龄组,≥75-79岁年龄组和≥80岁年龄组对老年人进行分层。随后,进行了mCRPC的单变量和多变量时间分析和总体生存分析.
结果:在494名老年人中,217(44%)分别为70-74岁和180(36%)75-79岁和97(20%)≥80岁。所有三组间局部前列腺癌治疗的比率显著不同(p<0.01)。关于mHSPC治疗,30-39%的患者使用了雄激素受体信号抑制剂(ARSI),70-74岁年龄组使用了9%的多西他赛,75-79岁和≥80岁年龄组使用了6%和3%的多西他赛.关于mCRPC治疗,观察到治疗比例之间存在显着差异(p<0.01)。所有三组最常见的治疗是ARSI。相反,化疗在70-74岁的患者中更为频繁(16%),相对于75-79岁和≥80岁患者的4%和3%。在单变量和多变量时间到mCRPC分析中,mHSPC和OS在mCRPC分析中的总生存率,所有3个年龄组之间均未观察到显著差异(均p≥0.3).
结论:老年转移性前列腺癌患者的治疗模式存在显著差异。然而,这些差异可能不会导致总体预期寿命的差异。
BACKGROUND: The landscape of systemic therapies for metastatic hormone-sensitive (mHSPC) and castration resistant prostate cancer (
mCRPC) extensively improved within the last decades resulting in a significantly prolonged overall survival. However, subgroup analyses of phase III trials suggest potentially different overall survival outcomes for older adults.
METHODS: We relied on our institutional metastatic prostate cancer database to identify mHSPC and subsequently
mCRPC patients. Older adults were stratified according to age groups 70-74 versus ≥75-79 versus ≥80 years at metastatic occurrence. Subsequently, uni- and multivariable time to
mCRPC and overall survival analyses were performed.
RESULTS: Of 494 older adults, 217 (44%) were 70-74 versus 180 (36%) 75-79 versus 97 (20%) ≥80 years old. Rates of local prostate cancer treatment differed significantly between all three groups (p < 0.01). Regarding mHSPC treatment, androgen receptor signaling inhibitors (ARSI) were administered in 30-39% of patients and docetaxel with 9% in age group 70-74 years and 6% and 3% in age groups 75-79 years and ≥80 years. Regarding
mCRPC treatment, significant differences between treatment proportions were observed (p < 0.01). Most common treatment was ARSI for all three groups. Conversely, chemotherapy was more frequently administered in patients aged 70-74 (16%), relative to 4% and 3% in 75-79 year and ≥80 year aged patients. In univariable and multivariable time to
mCRPC analyses, overall survival in mHSPC and OS in
mCRPC analyses, no significant differences between all three age groups were observed (all p ≥ 0.3).
CONCLUSIONS: Treatment patterns differ significantly between older adults with metastatic prostate cancer. However, these differences may not result in differences of overall life expectancy.