预后营养指数预测转移性去势抵抗前列腺癌患者阿比特龙初始耐药和预后

Prediction of prognostic nutritional index for the primary resistance to abiraterone and the prognosis in metastatic castration-resistant prostate cancer patients

目的·确定治疗前预后营养指数(prognostic nutritional index,PNI)及其变化是否可以用来判断阿比特龙(abiraterone,AA治疗转移性去势抵抗前列腺癌(metastatic castration-resistant prostate cancer,mCRPC)患者的初始疗效和预测患者预后。方法·纳入在上海交通大学医学院附属仁济医院泌尿科接受AA治疗的112例mCRPC患者。在AA治疗前及治疗1个月后根据患者的血清白蛋白水平、外周血淋巴细胞计数,计算PNI值[10×血清白蛋白水平(g/dL)+0.005×外周血淋巴细胞计数(μL^(-1))]。运用单因素和多因素Logistic回归分析确定判断AA治疗初始疗效的预测因素。进行单因素和多因素Cox回归分析以确定与前列腺特异性抗原(prostate-specific antigen,PSA)无进展生存期(PSA progression-free survival,PSA-PFS)、影像学无进展生存期(radiographic PFS,rPFS)和总生存期(overall survival,OS)相关的预测因素。结果·在112例mCRPC患者中,81例(72.3%)患者对AA治疗初始有效,其中15例患者在AA治疗期间出现了前列腺特异性抗原的闪烁现象。多因素Logistic回归分析结果显示,高基线PNI值、AA治疗1个月后PSA水平降低和AA治疗1个月后PNI值增加与对AA初始有效显著相关。多因素Cox回归分析结果显示,低基线PNI值是接受AA治疗患者OS、rPFS和PSA-PFS的独立预后预测因素。结论·独立于治疗后PSA水平变化,AA治疗1个月后PNI值增加和高基线PNI值与对AA初始有效显著相关。此外,治疗前低基线PNI值是AA治疗mCRPC患者较差预后的独立预测因素。

Objective · To determine whether pre-treatment prognostic nutritional index (PNI) level and its variation can predict the primary resistance to abiraterone (AA) and the prognosis in metastatic castration-resistant prostate cancer (mCRPC) patients treated with AA. Methods · A total of 112 mCRPC patients treated with AA were included in Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine. PNI levels were measured before and one month after AA treatment. PNI was calculated from preoperative laboratory parameters using the formula [10×serum albumin level (g/dL)+ 0.005×lymphocyte count (per μL) in the peripheral blood]. Univariate and multivariate Logistic regression analyses were used to identify predictive factors of initial efficacy to AA treatment. Univariable and multivariable Cox regression analyses were performed to determine the prognostic factors that were associated with prostate-specific antigen (PSA) progression-free survival (PSA-PFS), radiographic PFS (rPFS) and overall survival (OS). Results · Eighty-one of all 112 (72.3%) patients showed initial response to AA treatment, and 15 patients experienced PSA flare during AA treatment. In multivariate Logistic regression analysis, the high baseline PNI level, the decrease of PSA level during the first month of AA treatment and the elevation of PNI level during the first month of AA treatment were significantly correlated with the initial response to AA treatment. In multivariate Cox regression analyses, the low baseline PNI level remained significant predictor of OS, rPFS and PSA-PFS. Conclusion · Independent of PSA level variation, the elevation of PNI level during the first month of AA treatment and high baseline PNI level are significantly correlated with the initial response to AA treatment. In addition, low baseline PNI level is a negative independent prognosticator of survival outcomes in mCRPC patients treated with AA.