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Improved cancer-specific free survival and overall free survival in contemporary metastatic prostate cancer patients


Over the past decade, several systemic agents as Docetaxel, Cabazitaxel, Sipuleucel-T, Abiraterone and Enzalutamide have improved overall survival ( OS ) in metastatic prostate cancer ( mPCa ) patients.
However, to date the overall survival benefit was not demonstrated in population-based analysis.

Between 2004 and 2014, 19,047 men with de novo metastatic prostate cancer were identified within the SEER ( Surveillance Epidemiology and End Results ) database.
Median year of diagnosis resulted in two groups: historical ( 2004–2008 ) and contemporary ( 2009–2014 ).

Due to potentially important differences according to year of diagnosis, researchers relied on propensity score matching.
Propensity-score-matched Kaplan–Meier analyses and Cox regression models ( CRMs ) tested cancer-specific mortality ( CSM ) free survival and overall mortality ( OM ) free survival according to treatment period.

The propensity-score-matched cohort consisted of 8596 patients with metastatic prostate cancer. Of those, 4298 ( 50.0% ) were historical ( 2004–2008 ) and 4298 ( 50.0% ) were contemporary ( 2009–2014 ).

Cancer-specific mortality free survival rates and overall mortality free survival rate were 32 versus 36 months ( p less than 0.0001 ) and 26 versus 29 months ( p less than 0.0001 ) for, respectively, historical and contemporary patients.

In multivariable CRMs, patients diagnosed in contemporary years had lower cancer-specific mortality ( hazard ratio, HR=0.88; CI 0.82–0.93 ) and overall mortality ( HR=0.88; CI 0.84–0.93 ) risks compared to historical counterpart ( all p less than 0.0001 ).

In conclusion, this population-based study provides the first evidence of improved cancer-specific mortality free survival and overall mortality free survival in patients with de novo metastatic prostate cancer since the introduction of several systemic agents for patients with castration-resistant prostate cancer ( CRPC ). ( Xagena )

Bandini, M., Pompe, R.S., Marchioni, M. et al. Int Urol Nephrol 2017

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