Analysis Of The Prognostic Factors Of Docetaxel Combined With Endocrine Therapy For Metastatic Castration-resistant Prostate Cancer

Objective:Docetaxel combined with endocrine therapy is one of the most important methods for the treatment of metastatic castration-resistant prostate cancer,but there are still some patients with poor response to treatment,resulting in unsatisfactory life expectancy and low quality of life.This study analyzed the influence of common clinical indicators on the survival and prognosis of m CRPC patients treated with docetaxel,in order to provide a reference for clinicians to make treatment plans..Methods:The clinical data of patients with m CRPC treated with docetaxel in combination with endocrine therapy in the First Affiliated Hospital of Nanchang University and The People’s Hospital of Jiangxi Province from January 2011 to August 2020 were retrospectively analyzed.Included Gleason score at diagnosis,effective time of ADT(Androgen deprivation therapy,also known as castration therapy,a method to reduce androgen levels and inhibit the development of prostate cancer.Including two ways: one is surgical excision of bilateral testicles;The second is the use of endocrine therapy drugs.This article refers specifically to endocrine therapy),pre-chemotherapy Prostate specific antigen doubling time(PSADT),pre-chemotherapy PSA,pre-chemotherapy age,pre-chemotherapy ECOG score,and pre-chemotherapy Hemoglobin(Hb),pre-chemotherapy platelet(PLT),and so on.With the patients’ death or the time to the last follow-up as the end point,follow up the survival.The clinical data of the enrolled patients were analyzed by SPSS26.0statistical software.Survival time between groups was compared and survival time was calculated by Kaplan-Meier method,and univariate survival analysis was performed by log-rank,and multivariate COX regression analysis was performed for the significant univariate correlation factors.P<0.05 indicates statistical significance.According to the results of multivariate COX regression analysis,the prognostic alignment diagram were constructed by RStudio software.Results:Followed up to December 31,2021.69 patients were included.8 patients(12%)survived;Sixty-one patients(88%)died without loss to follow-up.The overall survival ranged from 8 to 52 months,with a median survival of 24 months(95%confidence interval 21.86 to 26.14).The number of cycles of chemotherapy completed by all patients ranged from 3 to 24,with a median of 7 cycles,and none of the patients experienced serious adverse chemotherapeutic drug reactions.Univariate analysis showed that Gleason score,effective time of ADT,pre-chemotherapy PSADT,Hgb and ALP,PSA were significant in the prognosis of m CRPC patients after chemotherapy(P < 0.05).Multivariate COX regression analysis showed that:pre-chemotherapy PSA level of patients was not correlated with patient survival time,and the difference was not statistically significant(P=0.384>0.05),effective duration of ADT(P=0.016 95%CI:1.148-3.782 HR:2.084),pre-chemotherapy PSADT(P=0.00295%CI:1.439-4.736 HR:2.610),pre-chemotherapy Hb(P=0.018 95%CI:1.157-4.801HR:2.357)and pre-chemotherapy Alkaline phosphatase(P=0.016 95%CI:0.200-0.844HR:0.411),Gleason score at diagnosis(P=0.020 95%CI: 0.201-0.871 HR:0.419).The above 5 factors are related to the prognosis of m CRPC patients after chemotherapy.According to the results of multivariate COX regression analysis,the prognostic alignment diagram was constructed,and the scores of 5 influencing factors were added to obtain the total score.Finally,the survival probability of prognosis 1,2,3years was determined by the total score.Conclusions:This study found that the effective duration of ADT,pre-chemotherapy ALP,PSADT,Hb and Gleason score were factors affecting the prognosis of m CRPC patients receiving docetaxel combined with endocrine therapy,and these factors should be evaluated before treatment for m CRPC patients receiving docetaxel combined with endocrine therapy.To facilitate clinical application,prognostic alignment diagram were constructed in this study to evaluate the survival prediction of patients with m CRPC treated with docetaxel combined with endocrine therapy.The model is expected to be a convenient personalized prediction tool to assist clinicians in clinical decision-making.According to different predicted outcomes,corresponding intervention measures can be made,such as improving anemia in patients with anemia before treatment;High-risk m CRPC patients such as short effective time of ADT,high pre-chemotherapy ALP,high Gleason score have a relatively poor prognosis.The review cycle should be shortened during treatment.In order to avoid low-benefit treatment,these patients should get other treatments as early as possible.