Background: The aim was to elaborate a predictive model to find responders for the corticosteroid switch (from prednisolone to dexamethasone) at the first prostate-specific antigen (PSA) progression (≥25% increase) during abiraterone acetate (AA) treatment of metastatic castration-resistant prostate cancer (mCRPC) patients. Methods: If PSA has decreased (≥25%) after switch, patients were considered responders. Logistic regression of 19 dichotomized parameters from routine laboratory and patients’ history was used to find the best model in a cohort of 67 patients. The model was validated in another cohort of 42 patients. Results: The model provided 92.5% and 90.5% accuracy in the testing and the validation cohorts, respectively. Overall the accuracy was 91.7%. The AUC of ROC curve was 0.92 (95% CI 0.85–0.96). After a median follow-up of 27.9 (26.3–84) months, the median AA+dexamethasone treatment duration (TD) in non-responders and responders was 4.7 (3.1–6.5) and 11.1 (8.5–12.9) months and the median overall survival (OS) was 23.2 (15.6–25.8) and 33.5 (26.1–38) months, respectively. Multivariate Cox regression revealed that responsiveness was an independent marker of TD and OS. Conclusions: A high accuracy model was developed for mCRPC patients in predicting cases which might benefit from the switch. For non-responders, induction of the next systemic treatment is indicated.
背景：本研究旨在构建一个预测模型，用于识别在醋酸阿比特龙（AA）治疗转移性去势抵抗性前列腺癌（mCRPC）过程中，首次出现前列腺特异性抗原（PSA）进展（增幅≥25%）时可能对皮质类固醇转换（从泼尼松龙转为地塞米松）产生应答的患者。方法：若转换后PSA下降（≥25%），则判定患者为应答者。研究纳入67例患者队列，通过对常规实验室检查及病史中19项二分类参数进行逻辑回归分析，构建最优预测模型，并在另一组42例患者队列中进行验证。结果：该模型在测试队列与验证队列中的准确率分别为92.5%和90.5%，总体准确率达91.7%。ROC曲线下面积（AUC）为0.92（95% CI 0.85–0.96）。中位随访27.9（26.3–84）个月后，非应答者与应答者的中位AA联合地塞米松治疗持续时间（TD）分别为4.7（3.1–6.5）个月和11.1（8.5–12.9）个月，中位总生存期（OS）分别为23.2（15.6–25.8）个月和33.5（26.1–38）个月。多变量Cox回归分析显示，治疗应答状态是TD与OS的独立预测因子。结论：本研究成功构建了高精度预测模型，可用于识别可能从皮质类固醇转换中获益的mCRPC患者。对于非应答者，建议及时启动后续系统治疗。
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