Screening for Predictive Factors of Efficacy of Second-Generation Androgen Receptor Axis-Targeted Agents in Patients With High-Risk Metastatic Hormone-Sensitive Prostate Cancer.
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Abstract
Background: Differences in the effectiveness of second-generation androgen receptor axis-targeted agents (ARATs) in high-risk metastatic hormone-sensitive prostate cancer (mHSPC) remain unclear. This study aimed to identify the factors influencing the efficacy of ARATs in patients with high-risk mHSPC and compare their long-term effectiveness.
Methods: Four hundred and sixty-six patients with mHSPC treated with ARATs were retrospectively recruited from our hospital and affiliated hospitals of the Kindai Oncology Study Group and Kyoto Prefectural University of Medicine Oncology Study Group between December 2013 and March 2024. Cox proportional hazards analysis was performed to identify prognostic factors for overall survival in patients with mHSPC. Propensity score matching was used to adjust for the differences in clinical backgrounds of the patients.
Results: Univariate and multivariable analyses revealed that Gleason pattern 5 and pretreatment ALP levels were notable prognostic factors for overall survival in patients with mHSPC treated with ARATs. In the subgroup of patients with high-risk mHSPC with Gleason pattern 5, apalutamide and enzalutamide showed significantly better outcomes in terms of PSA-PFS, PFS2, and overall survival compared to abiraterone acetate though selection bias and the small number of patients may be associated with the results in this study. Univariate and multivariable analyses suggested that ARATs selection (ABI vs. APA or ENZ) may serve as an independent predictor of overall survival in patients with high-risk mHSPC with Gleason pattern 5 treated with ARATs.
Conclusion: Gleason pattern 5 may be a predictive factor for ARAT efficacy in patients with high-risk mHSPCs.
背景：第二代雄激素受体轴靶向药物（ARATs）在高危转移性激素敏感前列腺癌（mHSPC）治疗中的有效性差异尚不清楚。本研究旨在确定影响高危mHSPC患者ARATs疗效的因素，并比较其长期疗效。方法：回顾性收集2013年12月至2024年3月期间我院及近代肿瘤研究组附属医院和京都府立医科大学肿瘤研究组466例接受ARATs治疗的mHSPC患者。进行Cox比例风险分析以确定影响mHSPC患者总生存期的预后因素。倾向评分匹配用于调整患者临床背景的差异。结果：单因素和多变量分析显示，Gleason模式5和预处理ALP水平是经ARATs治疗的mHSPC患者总生存期的显著预后因素。在Gleason模式5的高危mHSPC患者亚组中，阿帕鲁胺和恩杂鲁胺在PSA-PFS、PFS2和总生存率方面明显优于醋酸阿比龙，尽管本研究的结果可能与选择偏倚和患者数量少有关。单变量和多变量分析表明，ARATs的选择（ABI vs. APA或ENZ）可能是接受ARATs治疗的Gleason模式5型高危mHSPC患者总生存率的独立预测因子。结论：Gleason模式5可能是高危mHSPCs患者ARAT疗效的预测因素。
期刊介绍：
The Prostate is a peer-reviewed journal dedicated to original studies of this organ and the male accessory glands. It serves as an international medium for these studies, presenting comprehensive coverage of clinical, anatomic, embryologic, physiologic, endocrinologic, and biochemical studies.
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