Association of Bone Metastatic Burden With Survival Benefit From Prostate Radiotherapy in Patients With Newly Diagnosed Metastatic Prostate Cancer

作者：Adnan Ali, Alex Hoyle, Áine Haran, Chris Brawley, Adrian Cook, Claire Amos, J. Calvert, Hassan Douis, Malcolm D. Mason, David P. Dearnaley, Gerhardt Attard, Silke Gillessen, Mahesh Parmar, Christopher Parker, Matthew R. Sydes, Nicholas D. James, Noel W. Clarke · 发表于：JAMA Oncology · 年份：2021 · DOI：10.1001/jamaoncol.2020.7857 · 被引用次数：138 · 研究领域：Bone health and treatments、Prostate Cancer Treatment and Research、Management of metastatic bone disease

IMPORTANCE: Prostate radiotherapy (RT) improves survival in men with low-burden metastatic prostate cancer. However, owing to the dichotomized nature of metastatic burden criteria, it is not clear how this benefit varies with bone metastasis counts and metastatic site. OBJECTIVE: To evaluate the association of bone metastasis count and location with survival benefit from prostate RT. DESIGN, SETTING, AND PARTICIPANTS: This exploratory analysis of treatment outcomes based on metastatic site and extent as determined by conventional imaging (computed tomography/magnetic resonance imaging and bone scan) evaluated patients with newly diagnosed metastatic prostate cancer randomized within the STAMPEDE trial's metastasis M1 RT comparison. The association of baseline bone metastasis counts with overall survival (OS) and failure-free survival (FFS) was assessed using a multivariable fractional polynomial interaction procedure. Further analysis was conducted in subgroups. INTERVENTIONS: Patients were randomized to receive either standard of care (androgen deprivation therapy with or without docetaxel) or standard of care and prostate RT. MAIN OUTCOMES AND MEASURES: The primary outcomes were OS and FFS. RESULTS: A total of 1939 of 2061 men were included (median [interquartile range] age, 68 [63-73] years); 1732 (89%) had bone metastases. Bone metastasis counts were associated with OS and FFS benefit from prostate RT. Survival benefit decreased continuously as the number of bone metastas...