Risk factors for first spinal SRE development.

Skeletal-related events (SREs) are common in patients with bone metastases from castration-resistant prostate cancer (CRPC). Despite advances in prostate cancer treatment, clinically validated predictive models for SREs in CRPC patients with bone metastases remain elusive. This gap in prognostic tools hinders optimal patient management and treatment planning for this high-risk population. This study aimed to develop a prediction model for SRE by investigating potential risk factors and classifying them into different groups. This model can be used to identify patients at high risk of SREs who need close follow-up. Between 2004 and 2013, 68 male patients with bone metastases from CRPC who were treated at our institute were evaluated for survival without SREs and survival without SREs of the spinal cord. The study analyzed clinical data at enrollment to identify risk factors for initial and spinal SREs. Multivariate analysis revealed that a high count of metastatic vertebrae, along with visceral or lymph node metastases, were significant risk factors. Patients were categorized into four subgroups based on the number of vertebral metastases and presence of visceral or lymph node metastases: 1) extensive vertebral and both types of metastases, 2) extensive vertebral without additional metastases, 3) some vertebral with other metastases, 4) some vertebral without additional metastases. The first SRE and spinal SRE occurred significantly sooner in the first subgroup compared to others. Incidence rates at 12 months for the first SRE were 56%, 40%, 27%, and 5%, and for the first spinal SRE were 47%, 40%, 27%, and 0% respectively. Patients with extensive vertebral and additional metastases require vigilant monitoring to mitigate SREs.

骨骼相关事件（Skeletal-related events, SREs）在去势抵抗性前列腺癌（castration-resistant prostate cancer, CRPC）伴骨转移患者中较为常见。尽管前列腺癌治疗领域已取得诸多进展，但针对CRPC伴骨转移患者的SREs临床验证性预测模型仍付诸阙如。这一预后工具的空白，严重制约了这一高危人群的个体化优化管理与治疗方案制定。
本研究旨在通过探究潜在风险因素并对其进行分类，构建一款针对SREs的预测模型。该模型可用于识别需接受密切随访的SREs高风险患者。
2004年至2013年间，本机构收治的68例CRPC伴骨转移男性患者被纳入研究，对其无SREs生存期与无脊髓SREs生存期进行评估。研究通过分析患者入组时的临床数据，明确了初始SREs与脊髓SREs的风险因素。
多因素分析结果显示，转移椎体数量较多且合并内脏或淋巴结转移，为SREs发生的显著独立风险因素。研究人员根据椎体转移数量及是否存在内脏或淋巴结转移，将患者划分为四个亚组：1）广泛椎体转移且合并内脏及淋巴结转移；2）广泛椎体转移但无额外转移；3）少量椎体转移且合并其他转移；4）少量椎体转移且无额外转移。
相较于其余三个亚组，第一亚组患者的首次SREs与脊髓SREs发生时间显著更早。四个亚组的12个月首次SREs发生率分别为56%、40%、27%与5%，12个月首次脊髓SREs发生率则分别为47%、40%、27%与0%。
合并广泛椎体转移与额外转移的患者，需接受更为严密的监测，以降低SREs的发生风险。