醋酸阿比特龙或恩扎卢胺治疗转移性去势抵抗性前列腺癌的生存结局及影响因素分析  

Survival outcomes and influencing factors in patients with metastatic castration resistant prostate cancer treated with abiraterone acetate or enzalutamide

作　　者：程红涛 李忠孝 郑璐娜 李玉红 Hongtao CHENG;Zhongxiao LI;Luna ZHENG;Yuhong LI(Department of Urinary Surgery,Zhejiang Shuren University Shulan International Medical College Affiliated Shulan(Hangzhou)Hospital,Hangzhou 310022,China)

机构地区：[1]浙江树人学院树兰国际医学院附属树兰(杭州)医院泌尿外科,杭州310022

出　　处：《临床药物治疗杂志》2024年第10期27-32,共6页Clinical Medication Journal

基　　金：浙江省基础公益研究计划(LY21H150001);浙江省中医药科技计划(2023ZL593)。

摘　　要：目的探讨转移性去势抵抗性前列腺癌(mCRPC)患者接受一线新型雄激素受体靶向治疗(ARAT)的生存结局和影响因素。方法回顾性分析2020年1月至2021年6月就诊于树兰(杭州)医院的mCRPC患者,分析患者治疗后前列腺特异性抗原(PSA)下降程度、PSA最低点和最低点时间(TTN),观察不同患者总生存期(OS),并分析OS的影响因素。结果共纳入患者202例,阿比特龙治疗115例(阿比特龙单药治疗患者95例,联合化疗患者20例),恩扎卢胺治疗87例(恩扎卢胺单药治疗患者69例,联合化疗患者18例),随访至2024年6月,中位随访时间为25.9个月,患者中位OS为30(18,36)个月,阿比特龙组和恩扎卢胺组患者累计OS比较,差异无统计学意义(P>0.05)。阿比特龙和恩扎卢胺在单药治疗和联合化疗亚组分析中的OS无明显差异(P>0.05)。治疗后,恩扎卢胺组TTN、TTN≥7个月和PSA下降≥90%比例高于阿比特龙组(P<0.05);COX回归分析结果显示,TTN<7个月、PSA最低点≥2 ng/mL和PSA下降<90%是影响mCRPC患者生存期的独立危险因素(P<0.05)。0~1个危险因素患者的累计OS高于≥2个危险因素患者(P<0.001),≥2个危险因素患者中,阿比特龙联合化疗和恩扎卢胺联合化疗的亚组累计OS均高于单药治疗亚组(P<0.05)。结论在mCRPC患者中,阿比特龙与恩扎卢胺的OS无显著差异,但恩扎卢胺在PSA相关指标上更优;TTN、PSA最低点及PSA下降程度是影响OS的独立危险因素。Objective To investigate the survival outcomes and influencing factors in patients with metastatic castration resistant prostate cancer(mCRPC)who received first-line novel androgen receptor targeted therapy(ARAT).Methods A retrospective analysis was conducted on mCRPC patients who visited Shulan(Hangzhou)Hospital from January 2020 to June 2021.The extent of post-treatment PSA decline,the nadir of PSA,and the time to nadir(TTN)were analyzed.The overall survival(OS)of different patients was observed,and the factors influencing OS were analyzed.Results A total of 202 patients were included,with 115 cases treated with abiraterone acetate(95 cases with abiraterone monotherapy and 20 cases with combined chemotherapy),and 87 cases treated with enzalutamide(69 cases with enzalutamide monotherapy and 18 cases with combined chemotherapy).Follow-up was conducted until June 2024,with a median follow-up time of 25.9 months.The median OS of the patients was 30(18,36)months,and there was no statistically significant difference in cumulative OS between the abiraterone and enzalutamide groups(P>0.05).There was no significant difference in OS in subgroups treated with monotherapy and combined chemotherapy for both abiraterone and enzalutamide(P>0.05).Post-treatment,the proportion of enzalutamide group with TTN,TTN≥7 months,and PSA decrease≥90%was higher than that of the abiraterone group(P<0.05);COX regression analysis showed that TTN<7 months,PSA nadir≥2 ng/mL,and PSA decline<90%were independent risk factors for survival in mCRPC patients(P<0.05).Patients with 0 to 1 risk factors had a higher cumulative OS than those with≥2 risk factors(P<0.001),and in patients with≥2 risk factors,the cumulative OS of subgroups treated with abiraterone combined chemotherapy and enzalutamide combined chemotherapy was higher than that of monotherapy subgroups(P<0.05).Conclusion In mCRPC patients,there was no significant difference in OS between abiraterone and enzalutamide,but enzalutamide performed better in PSA related indicators;TTN,PS

关 键 词：醋酸阿比特龙 恩扎卢胺 转移性去势抵抗性前列腺癌 雄激素受体轴靶向治疗 总生存期 

分 类 号：R979.1[医药卫生—药品] R737.25[医药卫生—药学]