賀爾蒙失敗之轉移性前列腺癌於接受阿比特龍後疾病惡化之預後
洪晟鈞1、王賢祥1、李建儀1、楊晨洸1、陳卷書1、賀昊中1、裘坤元1、程千里1及歐宴泉1,2*
1臺中榮民總醫院醫院 外科部 泌尿科; 2臺中榮民總醫院 醫學研究部
Outcome of patients with metastatic castration-resistant prostate cancer after progressive disease of abiraterone acetate
Sheng-Chun Hung1, Shian-Shiang Wang1, Jian-Ri Li1, Cheng-Kuang Yang1, Chuan-Su Chen1, Hao-Chung Ho1, Kun-Yuan Chiu1, Chen-Li Cheng1, and Yen-Chuan Ou1,2*
1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, 2 Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
Purpose: We retrospective investigate the outcome of our patients with metastatic castration-resistant prostate cancer (mCRPC) after progressive disease (PD) of abiraterone acetate (AA).
Materials and Methods: From 2012 to 2016, 64 patients who received docetaxel after mCRPC followed by AA treatment were recorded. 59 of them experienced progressive disease during follow up were included in this study (PSA progression, PSA increase that is ≥ 25% and ≥ 2 ng/mL above the nadir, and which is confirmed by a second value 3 or more weeks later). Clinical parameters were recorded and analysis was performed to identify associations between treatment variables and outcome.
Results: 26 patients were response to AA initially at treatment while 33 patients were non-responder. The overall survival since beginning of AA seems longer in response group compared to non-response group and the medium time were 25 and 8 months (p=0.000). However, when looking at the survival time after PD of the two groups, it seems longer in response group but no statistical significance, while the medium survival time were 13 and 7 months (p=0.126). The medium time of overall survival of all patients after PD was 12 months (95% CI [7.6-16.4]) and a total 38 of 59 (64.4%) died during follow-up. Of the variables analysis using uni- and multivariable analysis model, the PSA at PD (HR 1.0, 95% CI [1.000–1.001], p=0.008) and bone metastasis PD (HR 3.8, 95% CI [1.146–12.423], p=0.029) appears independent associated with the survival time after PD of AA. Soft tissue PD (lymph node and visceral), which was thought a poor prognosis factors, seems a trend of significant in univariate model but less after correlation (HR 1.6, 95% CI [0.645–3.841], p=0.319).
Conclusions: Despite PD of second-line hormone therapy in patients with mCRPC, they still survive for a long time and survey for further sequential therapy may be benefit for these patients. PSA and bone progression are independent predictors to the survival after PD of disease.