转移性激素敏感前列腺癌的年龄和治疗强化
Alicia K Morgans1, Soumyajit Roy2, Angela Y Jia2
1Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston.
NEJM evidence
|October 28, 2025
概括
患有转移性激素敏感前列腺癌 (mHSPC) 的老年男性从治疗强化 (TI) 中受益较少. 年龄影响整体生存 (OS) 益处,老年男性从TI中获得的OS益处较小.
科学领域:
- 在瘤学瘤学.
- 老年医学 老年医学
- 临床试验 临床试验
背景情况:
- 患有转移性激素敏感前列腺癌 (mHSPC) 的老年男性往往有并发症和较高的非癌症死亡率.
- 在mHSPC中,年龄对系统性治疗强化 (TI) 的生存益处的影响尚未完全理解.
研究的目的:
- 调查是否年龄影响整体生存 (OS) 益处治疗强化 (TI) 使用雄激素受体通路抑制剂 (ARPIs) 和/或化疗在mHSPC.
- 分析TI对OS在年轻男性与老年男性mHSPC的差异性影响.
主要方法:
- 在mHSPC (2010-2024) 中对第三阶段随机试验进行系统文献搜索.
- 综合数据的元分析和元回归,年龄分化为70或75岁.
- 使用来自三个关键试验 (TITAN,ARASENS,LATITUDE) 的个人患者数据 (IPD) 的验证.
主要成果:
- 十一项试验 (13,648名患者) 显示TI改善了OS (HR 0.73).
- 年龄和TI在OS上的显著相互作用 (P<0.001);年轻的男性比年长的男性 (HR 0.82) 有更大的益处 (HR 0.63).
- 在老年男性中,TI在三重疗法中没有显示任何OS益处 (HR 0.94) 和在低体积疾病中有限的益处 (IPD HR 0.89).
结论:
- 年龄与mHSPC中TI的OS益处有显著的相互作用.
- 对于患有mHSPC的老年男性 (≥70岁) 的治疗策略,特别是那些患有低体积同步疾病的人,需要仔细考虑,可能有利于放射治疗.
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