Clinical significance of primary tumor progression in metastatic hormone-sensitive prostate cancer

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International Pub Date : 2025-03-01 DOI:10.1016/j.prnil.2024.11.005

Yasutaka Yamada , Shinichi Sakamoto , Takuya Tsujino , Sinpei Saito , Kodai Sato , Kazuki Nishimura , Tatsuo Fukushima , Ko Nakamura , Yuki Yoshikawa , Tomohisa Matsunaga , Ryoichi Maenosono , Manato Kanesaka , Takayuki Arai , Tomokazu Sazuka , Yusuke Imamura , Kazumasa Komura , Kazuo Mikami , Kazuyoshi Nakamura , Satoshi Fukasawa , Kazuto Chiba , Tomohiko Ichikawa

{"title":"Clinical significance of primary tumor progression in metastatic hormone-sensitive prostate cancer","authors":"Yasutaka Yamada , Shinichi Sakamoto , Takuya Tsujino , Sinpei Saito , Kodai Sato , Kazuki Nishimura , Tatsuo Fukushima , Ko Nakamura , Yuki Yoshikawa , Tomohisa Matsunaga , Ryoichi Maenosono , Manato Kanesaka , Takayuki Arai , Tomokazu Sazuka , Yusuke Imamura , Kazumasa Komura , Kazuo Mikami , Kazuyoshi Nakamura , Satoshi Fukasawa , Kazuto Chiba , Tomohiko Ichikawa","doi":"10.1016/j.prnil.2024.11.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Clinical significance of primary tumor progression in patients with metastatic hormone-sensitive prostate cancer (mHSPC) is unclear.</div></div><div><h3>Methods</h3><div>Clinical data from 987 patients with mHSPC from multiple institutions between September 1999 and November 2023 were reviewed. The prognostic impact of primary tumor progression was examined along with other clinical parameters. Castration-resistant prostate cancer progression-free survival (CRPC PFS) and overall survival (OS) were analyzed as clinical outcomes. Student's t-test, Cox proportional hazards models, and Kaplan-Meier methods were utilized to validate the clinical significance.</div></div><div><h3>Results</h3><div>The median age and initial prostate-specific antigen (iPSA) values were 74 and 221 ng/ml, respectively. 632 (64%) and 355 (36%) patients had clinical T stage ≤3 and 4 at diagnosis, respectively. mHSPC patients with clinical T stage 4 were more likely to have a higher grade group (GG), higher frequency of lymph node metastasis, lower hemoglobin (Hb), and more high-volume/risk disease in comparison with those with clinical T stage ≤3. Patients with cT4 were associated with shorter CRPC PFS (<em>P</em>=0.0002) and OS (<em>P</em> < 0.0001). Multivariate analysis identified cT4 as an independent prognostic factor for OS (HR=1.33, <em>P</em>=0.03) along with age, GG, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), albumin (Alb), and high-volume disease. After propensity score matching, patients with cT4 had unfavorable OS in comparison with those with ≤cT3 (<em>P</em>=0.0279). Furthermore, when combined with tumor volume, men with low-volume + cT4 achieved a prognosis comparable to that of patients with high-volume+≤cT3 and high-volume + cT4 (<em>P</em>=0.6876 and <em>P</em>=0.1679, respectively).</div></div><div><h3>Conclusion</h3><div>Bulkiness of primary prostate tumor was associated with worse outcomes in patients with mHSPC. Men with cT4 will require multimodal and intensive therapeutic strategies irrespective of tumor volume.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 1","pages":"Pages 60-66"},"PeriodicalIF":2.7000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Prostate International","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2287888224000874","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Clinical significance of primary tumor progression in patients with metastatic hormone-sensitive prostate cancer (mHSPC) is unclear.

Methods

Clinical data from 987 patients with mHSPC from multiple institutions between September 1999 and November 2023 were reviewed. The prognostic impact of primary tumor progression was examined along with other clinical parameters. Castration-resistant prostate cancer progression-free survival (CRPC PFS) and overall survival (OS) were analyzed as clinical outcomes. Student's t-test, Cox proportional hazards models, and Kaplan-Meier methods were utilized to validate the clinical significance.

Results

The median age and initial prostate-specific antigen (iPSA) values were 74 and 221 ng/ml, respectively. 632 (64%) and 355 (36%) patients had clinical T stage ≤3 and 4 at diagnosis, respectively. mHSPC patients with clinical T stage 4 were more likely to have a higher grade group (GG), higher frequency of lymph node metastasis, lower hemoglobin (Hb), and more high-volume/risk disease in comparison with those with clinical T stage ≤3. Patients with cT4 were associated with shorter CRPC PFS (P=0.0002) and OS (P < 0.0001). Multivariate analysis identified cT4 as an independent prognostic factor for OS (HR=1.33, P=0.03) along with age, GG, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), albumin (Alb), and high-volume disease. After propensity score matching, patients with cT4 had unfavorable OS in comparison with those with ≤cT3 (P=0.0279). Furthermore, when combined with tumor volume, men with low-volume + cT4 achieved a prognosis comparable to that of patients with high-volume+≤cT3 and high-volume + cT4 (P=0.6876 and P=0.1679, respectively).

Conclusion

Bulkiness of primary prostate tumor was associated with worse outcomes in patients with mHSPC. Men with cT4 will require multimodal and intensive therapeutic strategies irrespective of tumor volume.

查看原文本刊更多论文

转移性激素敏感前列腺癌原发肿瘤进展的临床意义

转移性激素敏感前列腺癌（mHSPC）患者原发肿瘤进展的临床意义尚不清楚。方法回顾1999年9月至2023年11月来自多家机构的987例mHSPC患者的临床资料。原发肿瘤进展对预后的影响与其他临床参数一起进行了检查。分析去势抵抗性前列腺癌无进展生存期（CRPC PFS）和总生存期（OS）作为临床结局。采用学生t检验、Cox比例风险模型和Kaplan-Meier方法验证临床意义。结果中位年龄和初始前列腺特异性抗原（iPSA）值分别为74和221 ng/ml。632例（64%）和355例（36%）患者在诊断时临床T期≤3期和4期。与临床T期≤3的mHSPC患者相比，临床T期4的mHSPC患者更有可能出现更高的分级组（GG）、更高的淋巴结转移频率、更低的血红蛋白（Hb）和更多的高容量/危险疾病。cT4患者与较短的CRPC PFS （P=0.0002）和OS (P <；0.0001)。多因素分析发现cT4与年龄、GG、乳酸脱氢酶（LDH）、碱性磷酸酶（ALP）、白蛋白（Alb）和大容量疾病一起是OS的独立预后因素（HR=1.33， P=0.03）。倾向评分匹配后，与≤cT3的患者相比，cT4患者的OS较差（P=0.0279）。此外，当结合肿瘤体积时，低体积+ cT4患者的预后与高体积+≤cT3和高体积+ cT4患者相当（P=0.6876和P=0.1679）。结论mHSPC患者原发性前列腺肿瘤体积大与预后差相关。无论肿瘤体积大小，cT4患者需要多模式和强化治疗策略。

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

Prostate International Medicine-Urology

CiteScore

4.40

自引率

26.70%

发文量

审稿时长

35 days

期刊介绍： Prostate International (Prostate Int, PI), the official English-language journal of Asian Pacific Prostate Society (APPS), is an international peer-reviewed academic journal dedicated to basic and clinical studies on prostate cancer, benign prostatic hyperplasia, prostatitis, and ...