Registrative trials recommended the use of upfront chemotherapy in high-volume metastatic prostate cancer. We reported survival outcomes of patients with high-volume mCRPC treated with ARTA in a chemo-naïve setting compared to patients treated with chemotherapy as first-line from a longitudinal real-life multicenter series. We retrospectively collected data on mCRPC patients treated at six centers. The dataset was queried for high-volume disease (defined as more than 6 bone lesions or bulky nodes ≥ 5 cm). We compared the main clinical features of chemo-naïve versus chemo-treated patients. The Mann–Whitney U test and Chi-squared test were used to compare continuous and categorial variables, respectively. The Kaplan–Meier method was used to compare differences in terms of progression-free survival (PFS), cancer specific survival (CSS) and overall survival (OS) in an upfront ARTA or chemo-treated setting. Survival probabilities were computed at 12, 24, 48, and 60 months. Out of 216 patients, 88 cases with high-volume disease were selected. Sixty-nine patients (78.4%) received upfront ARTA, while 19 patients received chemotherapy as the first-line treatment option. Forty-eight patients received Abiraterone (AA), 21 patients received Enzalutamide (EZ) as the first-line treatment. The ARTA population was older (p= 0.007) and less likely to receive further lines of treatment (p= 0.001) than the chemo-treated cohort. The five-year PFS, CSS and OS were 60%, 73.3%, and 72.9%, respectively. Overall, 28 patients (31.8%) shifted after their first-line therapy to a second-line therapy: EZ was prescribed in 17 cases, AA in seven cases and radiometabolic therapy in four patients. Sixteen cases (18.2%) developed significant progression and were treated with chemotherapy. At Kaplan–Meyer analysis PFS, CSS and OS were comparable for upfront ARTA vs chemo-treated patients (log rankp= 0.10,p= 0.64 andp= 0.36, respectively). We reported comparable survival probabilities in a real-life series of high-volume mCRPC patients who either received upfront ARTA or chemotherapy. Patients primarily treated with chemotherapy were younger and more likely to receive further treatment lines than the upfront ARTA cohort. Our data support the use of novel antiandrogens as first line treatment regardless tumor burden, delaying the beginning of a more toxic chemotherapy in case of significant disease progression.
注册试验推荐在高负荷转移性前列腺癌中使用前期化疗。我们报告了一项纵向真实世界多中心系列研究中，与一线接受化疗的患者相比，在未接受化疗情况下接受雄激素受体靶向药物治疗的高负荷转移性去势抵抗性前列腺癌患者的生存结局。我们回顾性收集了在六个中心接受治疗的转移性去势抵抗性前列腺癌患者的数据。从数据集中筛选出高负荷疾病患者（定义为超过6处骨转移病灶或淋巴结肿块≥5厘米）。我们比较了未接受化疗患者与接受化疗患者的主要临床特征。分别采用Mann-Whitney U检验和卡方检验比较连续变量和分类变量。使用Kaplan-Meier法比较前期接受雄激素受体靶向药物或化疗治疗在无进展生存期、癌症特异性生存期和总生存期方面的差异。计算了12、24、48和60个月的生存概率。在216例患者中，筛选出88例高负荷疾病患者。69例患者（78.4%）接受前期雄激素受体靶向药物治疗，19例患者接受化疗作为一线治疗方案。48例患者接受阿比特龙作为一线治疗，21例患者接受恩杂鲁胺作为一线治疗。与化疗组相比，雄激素受体靶向药物组患者年龄更大（p=0.007），接受后续治疗的可能性更低（p=0.001）。五年无进展生存率、癌症特异性生存率和总生存率分别为60%、73.3%和72.9%。总体而言，28例患者（31.8%）在一线治疗后转入二线治疗：其中17例接受恩杂鲁胺治疗，7例接受阿比特龙治疗，4例接受放射性核素治疗。16例患者（18.2%）出现显著进展并接受化疗治疗。Kaplan-Meier分析显示，前期接受雄激素受体靶向药物治疗与接受化疗患者的无进展生存期、癌症特异性生存期和总生存期具有可比性（对数秩检验p值分别为0.10、0.64和0.36）。我们在真实世界系列研究中报告了接受前期雄激素受体靶向药物或化疗治疗的高负荷转移性去势抵抗性前列腺癌患者具有可比的生存概率。与前期雄激素受体靶向药物组相比，主要接受化疗治疗的患者更年轻，更可能接受后续治疗。我们的数据支持无论肿瘤负荷如何，均可使用新型抗雄激素药物作为一线治疗，在疾病出现显著进展时延迟开始更具毒性的化疗。
肿瘤(癌症)患者之家