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针对低风险转移性割-敏感性前列腺癌的新治疗策略

Hiroaki Iwamoto¹, Tomohiro Hori¹, Ryunosuke Nakagawa¹

¹Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan.

|September 28, 2024

概括

确定在12周内对雄激素剥夺疗法 (ADT) 反应良好的患者对于转移性割敏感前列腺癌 (mCSPC) 治疗至关重要. 低于95%的PSA降低表明割抵抗的时间较短.

科学领域:

在瘤学瘤学.
泌尿器科泌尿器科泌尿器科泌尿器科

背景情况:

转移性割敏感前列腺癌 (mCSPC) 治疗已经发展,前期的雄激素受体信号抑制剂 (ARSIs) 往往是首选的.
然而,雄激素剥夺疗法 (ADT) 和联合雄激素阻断 (CAB) 在一些亚洲人群中显示出有效性.
识别对ADT的早期响应者是优化治疗和临床试验资格的关键.

研究的目的:

评估Canazawa风险分类系统对mCSPC的有效性.
在接受ADT治疗的mCSPC患者中确定时间到割抵抗 (TTCR) 的预测因子.
提出一种基于早期PSA对ADT反应的新型治疗策略.

主要方法:

对218名接受ADT治疗的mCSPC患者进行了回顾性分析.
使用了LATITUDE,CHAARTED和新的Canazawa分类 (格里森模式5,BSI≥1.5,LDH≥300IU/L) 来进行风险分层.
卡普兰-梅尔总生存率 (OS) 和TTCR估计方法;对TTCR预测因子的单变量和多变量分析.

主要成果:

卡纳扎瓦分类有效地区分了mCSPC患者的OS和TTCR.
多变量分析发现,在ADT后12周,PSA降低<95%作为短TTCR的预测因素,特别是在低风险,低体积的患者中.
随访时间中位数为40.4个月,中位数的生存期为85.2个月,中位数的TTCR为16.4个月.

结论:

卡纳扎瓦分类为mCSPC提供了明确的预后差异化.
低风险患者在ADT开始后12周的PSA降低率<95%预测TTCR较短.
提出了一项新策略:对低风险的mCSPC启动ADT,并根据12周的PSA反应切换到ARSIs.

关键词:

减少PSA降低率的比率雄激素剥夺疗法是一种治疗方法.结合的雄激素阻断阻断的结合.转移性割敏感的前列腺癌这是一种新的雄激素受体信号抑制剂.前列腺特异抗原的前列腺特异抗原.

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