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Clinical outcomes and prognostic factors in patients with newly diagnosed metastatic prostate cancer initially treated with androgen deprivation therapy: a retrospective multicenter study in Japan

  • Shintaro NaritaEmail author
  • Shingo Hatakeyama
  • Masahiro Takahashi
  • Toshihiko Sakurai
  • Sadafumi Kawamura
  • Senji Hoshi
  • Masanori Ishida
  • Toshiaki Kawaguchi
  • Shigeto Ishidoya
  • Jiro Shimoda
  • Hiromi Sato
  • Atsushi Koizumi
  • Koji Mitsuzuka
  • Tatsuo Tochigi
  • Norihiko Tsuchiya
  • Chikara Ohyama
  • Yoichi Arai
  • Kyoko Nomura
  • Tomonori Habuchi
Original Article

Abstract

Purpose

Clinical outcomes of patients with newly diagnosed metastatic hormone-naïve prostate cancer (mHNPC) and initially treated with androgen deprivation therapy (ADT) were evaluated.

Methods

The medical records of 605 consecutive mHNPC patients with initial ADT or combined androgen blockade (CAB) at nine study centers between 2008 and 2016 were retrospectively reviewed. Castration-resistant prostate cancer (CRPC)-free and overall survival (OS) were estimated by the Kaplan–Meier method. The association of pretreatment risk factors with CRPC-free survival and OS was evaluated by Cox proportional hazard models and differences in survival were classified by the number of risk factors.

Results

Median follow-up was 2.95 years, median CRPC-free survival was 21.9 months and median OS was 5.37 years. Multivariable analysis found that four risk factors, a Gleason score ≥ 9, lymph node metastasis, an extent of disease score ≥ 2, and serum LDH of > 220 IU were independently associated with both CRPC-free survival and OS. Median CRPC-free survival of low-risk patients with no or one factor was 86.5 months, 17.9 months in intermediate-risk patients with two or three factors, and 11.0 months in high-risk patients with four factors. Median OS was 4.72 years in intermediate- and 2.44 years in high-risk patients. It was not reached in low-risk patients.

Conclusion

In this series, CRPC-free and OS of a subset of mHNPC patients in Japan who were treated with ADT or CAB had better CRPC-free and overall survivals in Japan. Risk-adapted treatment based on the presence of novel prognostic factors may be beneficial for selected mHNPC patients.

Keywords

Androgen deprivation therapy Castration-resistant prostate cancer-free survival Hormone-naïve Hormone-sensitive Metastatic Overall survival Prostate caner 

Notes

Acknowledgements

We express our appreciation to Yoko Mitobe, Yukiko Sugiyama, Masako Nagata and Saeko Nakamura for their assistance in performing this study.

Author contributions

Narita: Data collection, statistical analysis, manuscript writing. Hatakeyama, Takahashi, Sakurai, Kawamura, Ishida, Sato, Mitsuzuka: Data collection. Hoshi, Kawaguchi, Ishidoya, Shimoda, Protocol development. Nomura: Data analysis. Tochigi, Tsuchiya, Ohyama, Arai, Habuchi: manuscript editing, supervision. All authors had read and approve of the final manuscript.

Funding

This study was supported in part by research grants from the MEXT/JSPS (Kakenhi, No. 19K09663).

Compliance with ethical standards

Conflict of interest

None declared. No competing financial interests exist.

Supplementary material

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Copyright information

© Japan Society of Clinical Oncology 2020

Authors and Affiliations

  • Shintaro Narita
    • 1
    • 11
    Email author
  • Shingo Hatakeyama
    • 2
    • 11
  • Masahiro Takahashi
    • 3
    • 11
  • Toshihiko Sakurai
    • 4
    • 11
  • Sadafumi Kawamura
    • 5
    • 11
  • Senji Hoshi
    • 6
    • 11
  • Masanori Ishida
    • 7
    • 11
  • Toshiaki Kawaguchi
    • 8
    • 11
  • Shigeto Ishidoya
    • 9
    • 11
  • Jiro Shimoda
    • 7
    • 11
  • Hiromi Sato
    • 1
  • Atsushi Koizumi
    • 1
  • Koji Mitsuzuka
    • 3
    • 11
  • Tatsuo Tochigi
    • 5
    • 11
  • Norihiko Tsuchiya
    • 4
    • 11
  • Chikara Ohyama
    • 2
    • 11
  • Yoichi Arai
    • 3
    • 11
  • Kyoko Nomura
    • 10
  • Tomonori Habuchi
    • 1
    • 11
  1. 1.Department of UrologyAkita University School of MedicineAkitaJapan
  2. 2.Department of UrologyHirosaki University School of MedicineHirosakiJapan
  3. 3.Department of UrologyTohoku University School of MedicineSendaiJapan
  4. 4.Department of UrologyYamagata University School of MedicineYamagataJapan
  5. 5.Department of UrologyMiyagi Cancer CenterNatoriJapan
  6. 6.Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
  7. 7.Department of UrologyIwate Prefectural Isawa HospitalOshuJapan
  8. 8.Department of UrologyAomori Prefectural Central HospitalAomoriJapan
  9. 9.Department of UrologySendai City HospitalSendaiJapan
  10. 10.Department of Public HealthAkita University School of MedicineAkitaJapan
  11. 11.Michinoku Japan Urological Cancer Study Group (MJUCSG)SendaiJapan

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