治疗相关性高血压是新发转移性激素敏感性前列腺癌的预后因素：一项回顾性真实世界证据研究

IF 3.2 3区医学 Q1 UROLOGY & NEPHROLOGY

European Urology Open Science Pub Date : 2024-11-19 DOI:10.1016/j.euros.2024.10.023

Giuseppe Salfi , Martino Pedrani , Selin Candan , Vasile Urechie , Sara Merler , Lorenzo Ruinelli , Amos Colombo , Luis Castelo-Branco , Irene Testi , Fabio Turco , Luigi Tortola , Ursula Vogl , Luca Gabutti , Silke Gillessen , Ricardo Pereira Mestre

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引用次数: 0

摘要

背景和目的高血压（HTN）与前列腺癌（PC）发病风险升高和局部病例预后较差有关，也是激素治疗 PC 的常见副作用。然而，它与转移性前列腺癌预后的关系仍不明确。我们评估了在接受雄激素剥夺疗法（ADT）单独治疗或与多西他赛或雄激素受体通路抑制剂（ARPIs）联合治疗的新发转移性激素敏感性PC（mHSPC）患者中，治疗相关高血压的预后作用。我们收集了从开始治疗到 ADT 开始 7 个月期间的临床变量、降压药物和血压数据。根据《不良事件通用毒性标准》5.0版对激素治疗开始后7个月内出现的高血压进行分级，并对阉割抵抗时间（TTCR）和总生存期（OS）进行Cox分析。在总体人群中，激素治疗开始后7个月内出现2-3级（G）高血压与单变量的TTCR和OS改善相关（TTCR：19.8 vs 7.9 mo，危险比[HR]：0.35，95%置信区间：0.35，95%置信区间：0.35）：0.35，95% 置信区间 [CI]：0.20-0.63, p < 0.001; OS：42月 vs 18.4月，HR：0.48，95% CI：0.26-0.87，p = 0.017）和多变量（TTCR：HR：0.41，95% CI：0.18-0.91，p = 0.029；OS：HR：0.42，95% CI：0.18-0.97，p = 0.042）分析。ADT+ARPI治疗人群的亚组分析显示，在TTCR和OS多变量生存分析中，7个月治疗相关的G2-3 HTN是一个独立的阳性预后因素（HR：0.30，95% CI：0.09-0.结论和临床意义激素治疗下 HTN 的早期发展或恶化可能与新发 mHSPC 患者更长的 TTCR 和 OS 相关。需要进行更大规模的研究来验证这些发现并探索其潜在的内在机制。我们发现，在肿瘤治疗早期出现临床上明显的血压毒性的患者生存期更长。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Treatment-related Hypertension as a Prognostic Factor for De Novo Metastatic Hormone-sensitive Prostate Cancer: A Retrospective Real-world Evidence Study

Background and objective

Hypertension (HTN) has been linked to an elevated risk of prostate cancer (PC) development and poorer prognosis in localized cases, and is a common side effect of hormonal PC treatments. However, its relationship with the prognosis of metastatic PC is still unclear. We assessed the prognostic role of treatment-related HTN in patients with de novo metastatic hormone-sensitive PC (mHSPC) undergoing androgen deprivation therapy (ADT) alone or in combination with docetaxel or androgen receptor pathway inhibitors (ARPIs).

Methods

Our retrospective analysis included 100 patients with de novo mHSPC treated with ADT, ADT + docetaxel, or ADT + ARPI between 2014 and 2021. Data on clinical variables, antihypertensive drugs, and blood pressure were collected from treatment initiation to 7 mo from ADT start. HTN development within 7 mo from hormonal treatment initiation was graded according to the Common Toxicity Criteria for Adverse Events version 5.0, and Cox analyses were performed for time to castration resistance (TTCR) and overall survival (OS).

Key findings and limitations

In the overall population, grade (G) 2–3 HTN development within 7 mo from hormonal treatment initiation was associated with improved TTCR and OS at both univariate (TTCR: 19.8 vs 7.9 mo, hazard ratio [HR]: 0.35, 95% confidence interval [CI]: 0.20–0.63, p < 0.001; OS: 42 vs 18.4 mo, HR: 0.48, 95% CI: 0.26–0.87, p = 0.017) and multivariate (TTCR: HR: 0.41, 95% CI: 0.18–0.91, p = 0.029; OS: HR: 0.42, 95% CI: 0.18–0.97, p = 0.042) analyses. A subgroup analysis of the ADT + ARPI–treated population revealed 7-mo treatment-related G2–3 HTN to be an independent positive prognostic factor in terms of both TTCR and OS multivariate survival analyses (HR: 0.30, 95% CI: 0.09–0.95, p = 0.040, and HR: 0.12, 95% CI: 0.02–0.57, p = 0.008, respectively).

Conclusions and clinical implications

The early development or worsening of HTN under hormonal treatment may be associated with longer TTCR and OS in de novo mHSPC patients. Larger studies are needed to validate these findings and explore the potential underlying mechanisms.

Patient summary

In this report, we examined the outcomes of patients with metastatic hormone-sensitive prostate cancer and their correlation with hypertension toxicities. We found that patients who developed clinically significant blood pressure toxicity early in oncological treatment experienced longer survival.

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