| Objective:To study the related factors of progression to metastatic castration-resistant prostate cancer(m CRPC)in oligo-metastatic prostate cancer(OMPCa)patients after different treatment regiments,and to screen out related prognostic indicators,providing theoretical basis for clinical treatment of OMPCa patients.Methods:Follow-up data of patients diagnosed with OMPCa in the Department of Urology,The First Affiliated Hospital of Nanchang University from June 2012 to June 2020 who received endocrine therapy,primary tumor reducing radical prostatectomy(CRP)combined with endocrine therapy,and neoadjuvant endocrine therapy(NHT)combined with CRP were collected.Patient age,body mass index(BMI),treatment regimen,baseline prostate specific antigen(PSA),PSA minimum(n PSA),time to PSA minimum(TTPN),alkaline phosphatase(ALP),lactate dehydrogenase(LDH),number of bone metastases,Gleason score,progression to m CRPC,and time to progression Etc.SPSS21.0 software was used to analyze the correlation between clinical factors and post-treatment progression to m CRPC in OMPCa patients.Univariate and multivariate analysis was conducted by Cox regression to identify independent predictors of progression to m CRPC in OMPCa patients after treatment.Kaplan-Meier method was used for survival function analysis to compare the effects of different clinical data on patients’ survival,and Log-rank method was used for significance test.Results:A total of 162 patients with OMPCa were included in this study.The last follow-up time was December 2022,and the follow-up time was 5-54 months.Clinical data analysis according to different treatment regimens showed no statistical difference in patients’ age,BMI,baseline PSA value,LDH,ALP,number of bone metastases,Gleason score and other clinical data(P>0.05).The progression rate of m CRPC in OMPCa patients in the endocrine therapy group was 65.6%.46.4% in the CRP combined with endocrine therapy group and 42.9% in the NHT combined with CRP group,the difference was statistically significant(P=0.033).Cox univariate regression analysis showed that whether OMPCa progressed to m CRPC was statistically significant in baseline PSA value,n PSA,TTPN,LDH,ALP,number of bone metastases,Gleason score,and treatment regimen(P<0.05;Cox multivariate regression analysis showed baseline PSA(HR,2.23;95%CI,1.19-4.18;P=0.013),n PSA(HR,4.23;95%CI,1.29-3.80;P=0.017),TTPN(HR,0.18;95%CI,0.09-0.35;P<0.001),the number of bone metastases(HR,2.47;95%CI,1.48-4.12;P=0.001),Gleason score(HR,2.00;95%CI,1.10-3.65;P=0.023),treatment plan(HR,0.39;95%CI,0.21-0.71;P=0.002)was an independent predictor of progression to m CRPC in OMPCa patients.Kaplan-Meier survival curve showed that OMPCa patients with baseline PSA> 20ng/ml,TTPN≤6 months,n PSA>0.2ng/ml,number of bone metastases >3,and Gleason score >8 had shorter progression-free survival(Log-rank)P<0.05).Conclusion:Both CRP combined with endocrine therapy and NHT combined with CRP reduced the rate of progression in OMPCa patients compared with endocrine therapy;Baseline PSA,n PSA,TTPN,number of bone metastases,Gleason score,and treatment regimen were independent predictors of progression to m CRPC in patients with oligo-metastatic prostate cancer.Patients with higher baseline PSA,n PSA,number of bone metastases,Gleason score,and shorter TTPN were more likely to progress to m CRPC.OMPCa patients treated with CRP combined with endocrine therapy and NHT combined with CRP were less likely to progress to m CRPC.OMPCa patients with baseline PSA> 20ng/ml,TTPN≤6 months,n PSA>0.2ng/ml,number of bone metastases >3,and Gleason score >8 had shorter PFS. |
