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）伴骨转移患者中十分常见。尽管前列腺癌治疗领域已取得诸多进展，但目前仍缺乏经临床验证的、针对此类患者SREs的预测模型。这一预后工具的空白，阻碍了这一高危人群的优化患者管理与治疗规划。本研究旨在通过探究潜在危险因素并将其划分为不同组别，构建SREs预测模型。该模型可用于识别需要密切随访的SREs高风险患者。2004年至2013年间，本中心收治的68例CRPC伴骨转移男性患者被纳入研究，对其无SREs生存期及无脊髓SREs生存期进行了评估。本研究分析了患者入组时的临床数据，以明确初始SREs及脊髓SREs的危险因素。多变量分析结果显示，转移性椎体数目较多、合并内脏或淋巴结转移，均为SREs发生的显著危险因素。研究人员根据患者的椎体转移数目及是否合并内脏/淋巴结转移，将其划分为4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。与其余三个亚组相比，第一亚组患者首次出现SREs及脊髓SREs的时间显著更早。各亚组12个月时首次SREs发生率分别为56%、40%、27%及5%，首次脊髓SREs发生率则分别为47%、40%、27%及0%。合并广泛椎体转移及额外转移的患者需接受严密监测，以降低SREs的发生风险。