WHAT CLINICAL FACTORS PREDICT OUTCOMES IN RECURRENT METASTATIC CASTRATE-SENSITIVE PROSTATE CANCER? RESULTS FROM THE SEARCH DATABASE

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2025-03-01 DOI:10.1016/j.urolonc.2024.12.064

John Heard, Galen Cook-Weins, Martha K. Terris MD, FACS, Zach Klaassen MD, Christopher J. Kane MD, Lourdes Guerrios Rivera MD, Matthew R. Cooperberg MD, MPH, William J. Aronson MD, Christopher L. Amling MD, FACS, Stephen J. Freedland MD

{"title":"WHAT CLINICAL FACTORS PREDICT OUTCOMES IN RECURRENT METASTATIC CASTRATE-SENSITIVE PROSTATE CANCER? RESULTS FROM THE SEARCH DATABASE","authors":"John Heard, Galen Cook-Weins, Martha K. Terris MD, FACS, Zach Klaassen MD, Christopher J. Kane MD, Lourdes Guerrios Rivera MD, Matthew R. Cooperberg MD, MPH, William J. Aronson MD, Christopher L. Amling MD, FACS, Stephen J. Freedland MD","doi":"10.1016/j.urolonc.2024.12.064","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Approximately one third of patients with prostate cancer (PC) undergoing radical prostatectomy (RP) develop biochemical recurrence within 10 years. PC in these men is heterogenous, with most following an indolent course, however up to one third will progress to metastatic castrate sensitive disease (mCSPC). Patient and clinical factors associated with progression from non-metastatic PSA recurrence to mCRPC or death include increased age, shorter time from surgery to recurrence, higher Gleason grade (PC specific tumor grade), and shorter PSA doubling time (PSADT). The factors that influence disease progression once patients develop mCSPC are unknown.</div></div><div><h3>Methods</h3><div>After obtaining IRB approval, the SEARCH database was created by combining data on 9,928 patients who underwent RP from 1982 to 2020 at eight VA Medical Centers across the U.S. Patients with recurrent mCSPC after RP were selected for analysis. Those treated with preoperative ADT or radiation therapy were excluded, as were patients who developed CRPC prior to metastasis. Patients who received ADT more than 3 months prior to metastasis were excluded. Of the 278 men who met these criteria, 153 were excluded due to missing data. We used multivariable cox proportional hazards regression modeling to assess the association between clinical variables at the time of mCSPC and the primary outcome of overall mortality (OM).</div></div><div><h3>Results</h3><div>Of 125 patients with recurrent mCSPC, median age at metastasis was 70. Median time from surgery to metastasis was 61 months. During follow-up, 60 patients (48%) progressed to mCRPC while 56 (45%) died from PC and 81 (65%) died from any cause. Shorter PSADT was the only clinical or pathologic feature associated with progression to OM (HR = 0.98, p < 0.0001). Patients were divided into groups based on PSADT widely used in non-metastatic biochemical recurrence (<3, 3-8.9, >9 months). On multivariable analysis, PSADT <3 months and 3-8.9 months were associated with worse overall survival (OS) than PSADT >9 months (Table 1). Median time to OS and 5-year OS rates were 93 months and 64% for PSADT >9 months, 47 months and 41% for 3-8.9 months, and 25 months and 12% for <3 months.</div></div><div><h3>Conclusions</h3><div>Outcomes for patients with recurrent mCSPC after RP were driven primarily by PSADT rather than other clinical features, including Gleason score. Our data demonstrates that patients with PSADT < 9 months have rapidly progressive disease that warrants aggressive treatment and inclusion in clnical trials. In contrast, those with PSADT > 9 months have a more indolent course despite the presence of metastases and may be candidates for deintensificaiton strategies.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 25-26"},"PeriodicalIF":2.4000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urologic Oncology-seminars and Original Investigations","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1078143924008445","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Approximately one third of patients with prostate cancer (PC) undergoing radical prostatectomy (RP) develop biochemical recurrence within 10 years. PC in these men is heterogenous, with most following an indolent course, however up to one third will progress to metastatic castrate sensitive disease (mCSPC). Patient and clinical factors associated with progression from non-metastatic PSA recurrence to mCRPC or death include increased age, shorter time from surgery to recurrence, higher Gleason grade (PC specific tumor grade), and shorter PSA doubling time (PSADT). The factors that influence disease progression once patients develop mCSPC are unknown.

Methods

After obtaining IRB approval, the SEARCH database was created by combining data on 9,928 patients who underwent RP from 1982 to 2020 at eight VA Medical Centers across the U.S. Patients with recurrent mCSPC after RP were selected for analysis. Those treated with preoperative ADT or radiation therapy were excluded, as were patients who developed CRPC prior to metastasis. Patients who received ADT more than 3 months prior to metastasis were excluded. Of the 278 men who met these criteria, 153 were excluded due to missing data. We used multivariable cox proportional hazards regression modeling to assess the association between clinical variables at the time of mCSPC and the primary outcome of overall mortality (OM).

Results

Of 125 patients with recurrent mCSPC, median age at metastasis was 70. Median time from surgery to metastasis was 61 months. During follow-up, 60 patients (48%) progressed to mCRPC while 56 (45%) died from PC and 81 (65%) died from any cause. Shorter PSADT was the only clinical or pathologic feature associated with progression to OM (HR = 0.98, p < 0.0001). Patients were divided into groups based on PSADT widely used in non-metastatic biochemical recurrence (<3, 3-8.9, >9 months). On multivariable analysis, PSADT <3 months and 3-8.9 months were associated with worse overall survival (OS) than PSADT >9 months (Table 1). Median time to OS and 5-year OS rates were 93 months and 64% for PSADT >9 months, 47 months and 41% for 3-8.9 months, and 25 months and 12% for <3 months.

Conclusions

Outcomes for patients with recurrent mCSPC after RP were driven primarily by PSADT rather than other clinical features, including Gleason score. Our data demonstrates that patients with PSADT < 9 months have rapidly progressive disease that warrants aggressive treatment and inclusion in clnical trials. In contrast, those with PSADT > 9 months have a more indolent course despite the presence of metastases and may be candidates for deintensificaiton strategies.

查看原文本刊更多论文

哪些临床因素可以预测复发转移性去势敏感前列腺癌的预后？来自搜索数据库的结果

大约三分之一接受根治性前列腺切除术（RP）的前列腺癌（PC）患者在10年内发生生化复发。这些男性的前列腺癌是异质的，大多数是惰性病程，然而多达三分之一的人会发展为转移性去势敏感疾病（mCSPC）。从非转移性PSA复发到mCRPC或死亡相关的患者和临床因素包括年龄增加，从手术到复发的时间缩短，更高的Gleason分级（PC特异性肿瘤分级）和更短的PSA倍增时间（PSADT）。一旦患者发生mCSPC，影响疾病进展的因素尚不清楚。方法在获得IRB批准后，通过合并1982年至2020年在美国8个VA医疗中心接受RP的9,928例患者的数据创建SEARCH数据库。术前接受ADT或放射治疗的患者被排除在外，在转移前发生CRPC的患者也被排除在外。排除转移前3个月以上接受ADT治疗的患者。在符合这些标准的278名男性中，153名因缺少数据而被排除在外。我们使用多变量cox比例风险回归模型来评估mCSPC时的临床变量与总死亡率（OM）的主要结局之间的关系。结果125例复发性mCSPC患者，转移时中位年龄为70岁。从手术到转移的中位时间为61个月。随访期间，60例（48%）进展为mCRPC， 56例（45%）死于PC， 81例（65%）死于任何原因。较短的PSADT是与进展为OM相关的唯一临床或病理特征(HR = 0.98,p <；0.0001)。根据PSADT在非转移性生化复发中的广泛应用（< 3,3 -8.9, >；9个月）将患者分为两组。在多变量分析中，PSADT 3个月和3-8.9个月的总生存期（OS）比PSADT 9个月更差（表1）。PSADT 9个月至OS的中位时间和5年OS率分别为93个月和64%，3-8.9个月为47个月和41%，3个月为25个月和12%。结论：RP后复发性mCSPC患者的预后主要由PSADT而不是其他临床特征（包括Gleason评分）驱动。我们的数据表明，PSADT患者9个月的患者病情进展迅速，需要积极治疗并纳入临床试验。相比之下，那些患有PSADT的人尽管存在转移，但9个月的病程较为缓慢，可能需要采取去强化策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.