现代泌尿生殖肿瘤杂志

目的 分析转移性激素敏感性前列腺癌(mHSPC)患者接受常用内分泌治疗方案的疗效及安全性,为mHSPC的治疗提供经验。方法 回顾性筛选2021年12月至2023年12月联勤保障部队第九四○医院泌尿外科确诊的共计114例mHSPC患者,分为阿帕他胺片+雄激素剥夺治疗(ADT)组、阿比特龙+ADT组和比卡鲁胺+ADT组,分析患者的基本资料,按照PSA工作组2标准计算PSA缓解率,分析PSA基线水平、肿瘤T分期、Gleason评分等指标对各治疗组PSA缓解率及影像学反应的差异,数据分析两两比较,使用独立样本t检验对应的非参数检验方法 MannWhitney U检验,多组独立样本比较采用Kruskal-Wallis H检验。结果 统计学分析显示,阿帕他胺组、阿比特龙组的PSA90优于比卡鲁胺组(81.25%vs 78.95%vs 56.82%,P=0.03),差异有统计学意义;高危组中阿帕他胺组的PSA90优于阿比特龙组和比卡鲁胺组(90.7%vs 61.9%vs47.8%,P=0.011),差异有统计学意义;阿帕他胺组、阿比特龙组及比卡鲁胺组影像学反应率(84.4%vs 78.9%vs 63.6%,P=0.094)比较差异无统计学意义;阿帕他胺组及比卡鲁胺组不良反应发生率高于阿比特龙组(28.1%vs 55.3%vs 15.9%,P<0.01),差异有统计学意义。结论 在真实世界中,阿帕他胺和阿比特龙在mHSPC患者中显示出比比卡鲁胺更好的疗效,尤其是对于高危组的mHSPC患者,通过阿帕他胺治疗可以获得更好的临床获益。同时阿帕他胺的不良反应率较低,对阿比特龙不耐受的患者可考虑选用阿帕他胺进行治疗。

Objective To analyze the efficacy and safety of common endocrine treatment regimens for patients with metastatic hormone-sensitive prostate cancer(mHSPC) and to provide experience for the treatment of mHSPC. Methods A total of 114 mHSPC patients diagnosed at the Department of Urology, The 940 th Hospital of Joint Logistics Support Force from December 2021 to December 2023 were selected and divided into three groups: apalutamide+ ADT, abiraterone+ADT, and bicalutamide+ADT. Basic patient data were analyzed, and the PSA response rate was calculated according to the Prostate Specific Antigen working group 2 standards. Differences in baseline PSA levels, tumor T staging, Gleason scores, etc., were analyzed in terms of their impact on PSA response rates and radiographic responses among treatment groups. Results Statistical analysis showed that the PSA90 response rates were significantly higher in the apalutamide and abiraterone groups than in the bicalutamide group(81.25% vs 78.95% vs 56.82%, P=0.03). In the high-risk subgroup, the PSA90 response rate was significantly higher in the apalutamide group than in the abiraterone and bicalutamide groups(90.7% vs 61.9% vs 47.8%, P=0.011). The radiographic response rates were 84.4%, 78.9%, and 63.6% in the apalutamide, abiraterone, and bicalutamide groups, respectively(P=0.094), with no statistically significant difference. The incidence of adverse reactions was significantly lower in the apalutamide and bicalutamide groups than in the abiraterone group(28.1% vs 55.3% vs 15.9%, P< 0.01). Conclusions In this real-world study, both apalutamide and abiraterone demonstrated superior efficacy to bicalutamide in mHSPC patients. Apalutamide provided particularly better clinical benefit in highrisk mHSPC patients. Moreover, apalutamide was associated with a lower incidence of adverse reactions, making it a suitable alternative for patients intolerant to abiraterone.