不同順序化療或第二代雄性激素受體拮抗劑治療荷爾蒙抗性攝護腺癌之比較

蔡牧堯、王弘仁、李維菁、莊燿吉、陳彥達、鄭元佐、康智雄、李偉嘉、陳建旭、沈元琦、柳易揚、劉惠瑛、張殷綸、楊文洲、江博暉、羅浩倫

高雄長庚紀念醫院 外科部 泌尿科；

Comparison of Chemotherapy and Androgen Receptor Targeted Agents as Sequencing Treatment in Castration Resistance Prostate Cancer

Mu-Yao Tsai¹, Hung-Jen Wang , Wei-Ching Lee, Yao-Chi Chuang, Yen-Ta Chen, Yuan-Tso Cheng, Chih-Hsiung Kang, Wei-Chia Lee, Hao-Lun Luo, Chien-Hsu Chen, Yuan-Chi Shen, , Yi Yang Liu, Hui Ying Liu, Yin Lun Chang, Wen-Chou Yang, Po-Hui Chiang, Hao-Lun Luo

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung,

Purpose: To evaluate whether earlier chemotherapy yields better survival benefits in sequencing treatment of castration resistance prostate cancer (CRPC)

Materials and Methods: 456 cases of CRPC from 2001 to 2020 were retrospectively collected at Kaohsiung Chang Gung Memorial Hospital. The cohort included 132 cases, 52 patients received earlier chemotherapy (Docetaxel) followed by Androgen Receptor Targeted Agents (ARTA) treatment (Abiraterone or Enzalutamide) and 80 patients received ARTA treatment as first treatment followed by chemotherapy. The primary endpoint was prostate specific antigen (PSA) response from the baseline. Overall survival (OS) and cancer-specific survival (CSS) were included as second endpoint.

Results: Totally 37 patients (80.4%) receiving chemotherapy as 1^st treatment showed Gleason score ≥8, comparing with 46 patients (71.9%) receiving ARTS. Patients receiving earlier chemotherapy demonstrated significant PSA decreasing 90% (1^st chemotherapy vs. 1^st ARTA: 37% vs. 10.9%, p=0.002). No significant difference were found in ARTA type, high volume prostate cancer patients (1^st chemotherapy vs. 1^st ARTA: 82.6% vs. 82.8%, p=1.000), nor high risk prostate cancer patients (1^st chemotherapy vs. 1^st ARTA: 69.6% vs. 75%, p=0.679)

Conclusions:  Chemotherapy as 1^st treatment in sequencing treatment followed by ARTA in CRPC patients showed greater response in PSA decreasing >90% from the baseline. Our data indicated earlier chemotherapy may improve the clinical outcomes in CRPC patients.