| Objective: To investigate the predictive factors for resistance to initial treatment in metastatic castration-resistant prostate cancer(m CRPC)patients treated with abiraterone acetate(AA),for providing scientific evidence for the rational application of AA in m CRPC patients and improve their prognosis.Methods: The clinical data of 120 m CRPC patients receiving AA treatment in our hospital from January 2016 to October 2020 were retrospectively analyzed,and a total of 94 m CRPC patients meeting the research criteria were finally included.All patients were administered with oral AA(1000 mg daily)and prednisone acetate(5 mg twice daily).We collected the potential predictors related to resistance to AA initial treatment in m CRPC patients,including the following indicators:(1)histopathological features :Gleason score,nerve invasion,lymphovascular invasion;(2)history of prior treatment :chemotherapy,radiotherapy,effective duration of androgen deprivation treatment(ADT);(3)general clinical data before AA treatment :age,body mass index(BMI),Eastern Cooperative Oncology Group(ECOG)score;(4)results of serological examination before AA treatment :prostate-specific antigen(PSA),lactic dehydrogenase(LDH),alkaline phosphatase(ALP),white blood cell(WBC),neutrophil(NEUT),lymphocyte(LY),neutrophil-to-lymphocyte ratio(NLR),albumin(ALB),prognostic nutritional index(PNI);(5)systemic metastasis before AA treatment :bone metastasis,visceral metastasis,lymph node metastasis.All pathologic specimens were obtained from the first puncture biopsy or operation.Univariate and multivariate logistic regression analysis were performed to explore the independent predictors of resistance to initial treatment of AA in m CRPC patients.We combined these independent predictors to construct a scoring system that predicts resistance to initial treatment of AA in m CRPC patients.The receiver operating characteristic curve(ROC)was used to evaluate the scoring system’s ability to predict resistance to AA initial treatment in m CRPC patients.Results: A total of 94 m CRPC patients meeting the research criteria were finally included.The follow-up duration was 6 months.All cases were divided into AA initial treatment resistance group(31 cases)and effective group(63 cases)according to the results of serological and imaging examination during the follow-up period.Univariate logistic regression analysis showed that pathological specimen neural invasion,effective duration of ADT,ECOG score,LDH level,ALP level,ALB level,NLR,and PNI before AA treatment were associated with resistance to AA initial treatment(P<0.05).Multivariate logistic regression analysis revealed that pathological specimen neural invasion,effective duration of ADT,ECOG score,ALP level,and NLR before AA treatment were independent predictors of resistance to AA initial treatment in m CRPC patients(P <0.05).The area under the ROC curve of these five independent predictors is 0.648,0.628,0.647,0.678,0.670,respectively.The sensitivity and specificity of nerve invasion are 61.3% and 68.3%,respectively.The optimal cut-off value for the effective duration of ADT treatment is 21.5 months with sensitivity and specificity of 80.6% and 50.8%,respectively.The sensitivity and specificity of an ECOG score of 2 are 48.4% and 81.0%,respectively.The optimal cut-off value of ALP level before AA treatment is 103.5U/L with sensitivity and specificity of 67.7% and 69.2%,respectively.The optimal cut-off value of NLR level before AA treatment is 2.452 with sensitivity and specificity of 80.6% and 52.4%,respectively.In the scoring system constructed by combining 5 independent predictors to predict the resistance to the initial treatment of AA in m CRPC patients,it was found that the majority of m CRPC patients with a score greater than 3 developed resistance to the initial treatment of AA.The area under the ROC curve of the scoring system is 0.840.The corresponding sensitivity and specificity are 61.3% and 93.7% with cutoff value of 3 points,indicating that the scoring system has high sensitivity and specificity in predicting resistance to initial treatment of AA in patients with m CRPC.Conclusion: Pathological specimen nerve invasion,effective duration of ADT,the ECOG score,ALP level,and NLR level before AA treatment were independent predictors of resistance to AA initial treatment in m CRPC patients.These five independent predictors have a moderate predictive ability for resistance to the initial treatment of AA in m CRPC patients.The new scoring system combining these five predictors could more accurately assess the treatment effect of AA on m CRPC patients,which might contribute to provide more reliable basis for AA treatment selection in mCRPC patients. |
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