探討治療荷爾蒙抗性攝護腺癌之最佳順序—高雄長庚紀念醫院之回溯式研究

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；

Optimal sequencing treatment in castration resistance prostate cancer—A retrospective study in Kaohsiung Chang Gung Memorial Hospital

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 which optimal sequencing treatment of castration resistance prostate cancer (CRPC) yields better survival benefits

Materials and Methods: 492 cases of CRPC from 2001 to 2020 were retrospectively collected at Kaohsiung Chang Gung Memorial Hospital. The cohort included 334 cases, 246 patients received earlier chemotherapy (Docetaxel) followed by Androgen Receptor Targeted Agents (ARTA) treatment (Abiraterone or Enzalutamide) and 88 patients received ARTA treatment as first treatment followed by chemotherapy. The primary endpoint was Overall survival (OS) and cancer-specific survival (CSS). Prostate specific antigen (PSA) response from the baseline, 1^st treatment duration and time to 2^nd treatment were included as second endpoint.

Results: Patients receiving earlier ARTA treatment demonstrated better OS (1^st chemotherapy vs. 1^st ARTA: 49.2% vs. 15.9%, p<0.001) and CSS (1^st chemotherapy vs. 1^st ARTA: 14.8% vs. 4.5%, p=0.02). Besides, significant PSA decreasing 90% (1^st chemotherapy vs. 1^st ARTA: 30.6% vs. 48.3%, p=0.005). Subgroup analysis showed high volume prostate cancer patients receiving 1^st treatment with ARTA had better overall OS and CSS (1^st chemotherapy vs. 1^st ARTA: 49.2% vs. 9.4%, p<0.001, 1^st chemotherapy vs. 1^st ARTA: 13.8% vs. 0%, p=0.009, respectively). In addition, ARTA as 1^st treatment in CRPC revealed longer duration of 1^st treatment (1^st chemotherapy vs. 1^st ARTA: 3.65m v.s 9.23m, p<0.001) and time to 2^nd treatment (1^st chemotherapy vs. 1^st ARTA: 4.67m v.s 16.20m, p<0.001).

Conclusions:  ARTA as 1^st treatment in sequencing treatment followed by chemotherapy in CRPC patients showed greater OS and CSS. The analysis of 1^st treatment duration and time to 2^nd treatment also favored ARTA as 1^st treatment in CRPC. Our data indicated earlier ARTA may improve the clinical outcomes in CRPC patients.