Prognostic importance of concomitant non‐regional lymph node and bone metastases in men with newly diagnosed metastatic prostate cancer

医学 相伴的 前列腺癌 危险系数 淋巴结 比例危险模型 癌症 队列 内科学 泌尿科 前列腺 回顾性队列研究 肿瘤科 阶段(地层学) 置信区间 古生物学 生物
作者
Berdine L. Heesterman,Henk G. van der Poel,Ivo G. Schoots,Niven Mehra,Katja K.H. Aben
出处
期刊:BJUI [Wiley]
卷期号:130 (2): 217-225 被引量:9
标识
DOI:10.1111/bju.15632
摘要

Objectives To evaluate the prognostic importance of concomitant non‐regional lymph node (NRLN) and bone metastases in men with synchronous metastatic hormone‐sensitive prostate cancer (mHSPC), and to determine whether M1b/M1c is the most appropriate M‐stage and evaluate the additional importance to the distinction in low/high volume disease. Patients and Methods All men diagnosed with synchronous mHSPC from 2010 to 2018 in the Netherlands were identified in the Netherlands Cancer Registry. Men were categorised as having NRLN (M1a), bone (M1b), NRLN and bone (M1c), or visceral metastases (M1c). For men diagnosed since October 2015 disease volume could be determined. Analyses were performed in this cohort (>5600 men) and repeated in the 2010–2018 cohort (>14 000 men). The primary outcome measure in this observational cohort study was overall survival (OS) and Cox regression was used to calculate hazard ratios (HRs). Results Compared to men with NRLN and bone metastases (reference group), OS of men with only NRLN (HR 0.70, 95% confidence interval [CI] 0.55–0.88) was better. This was also true for men with only bone metastases in the low‐volume subgroup (HR 0.75, 95% CI0.58–0.98), but not in the high‐volume subgroup (HR 0.99, 95% CI 0.84–1.18). In contrast, the OS of men with visceral metastases was worse (HR 2.20, 95% CI 1.75–2.77 + 0.97/month, 95% CI 0.96–0.98). Conclusion In men with low‐volume synchronous mHSPC, presence of concomitant NRLN and bone metastases (currently classified as M1c), is a poor prognostic sign. However, survival of men with visceral metastases (M1c) is worse. Implying that classifying concomitant NRLN and bone metastases as M1c or M1b is not appropriate. Adding a fourth M1‐category to the ninth edition of the Tumour‐Node‐Metastasis classification should be contemplated. Furthermore, definitions of metastatic burden need to be re‐evaluated.
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