Survival outcomes and influencing factors in patients with metastatic castration resistant prostate cancer treated with abiraterone acetate or enzalutamide
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,PSA nadir,and the extent of PSA decline are independent risk factors affecting OS.
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