Statin Use in Patients With Advanced Prostate Cancer in the TITAN and SPARTAN Trials
Notice bibliographique
Résumé
Importance: The impact of statins on overall survival (OS) in patients with prostate cancer treated using intensified therapy with apalutamide is not fully understood. Objective: To determine whether statin exposure was associated with OS and grade 3 or greater cardiac adverse events (AEs) in patients treated with apalutamide. Design, Setting, and Participants: This cohort study used individual patient data from 2 multicenter phase 3 randomized clinical trials, SPARTAN (October 14, 2013, to December 15, 2016) and TITAN (December 15, 2015, to July 25, 2017). The final analysis was done on May 21, 2025. TITAN and SPARTAN randomized patients to receive androgen deprivation therapy with or without apalutamide in metastatic hormone-sensitive prostate cancer (TITAN) and nonmetastatic castration-resistant prostate cancer (SPARTAN). Exposure: Statin exposure during the assigned treatment; statin exposure could have started before and ended either during or after the assigned treatment. Main Outcomes and Measures: Inverse probability of treatment-weighted (IPTW) multivariable Cox proportional hazard regression model and covariate-adjusted OS were estimated for patients with and without statin exposure in each trial. Fine and Gray regression models were applied to determine the association of statin exposure with risk of grade 3 or greater cardiac AEs, considering deaths as competing events. Results: Among 2187 patients included in this analysis, 1288 received apalutamide (517 in TITAN; 770 in SPARTAN) and 900 received placebo. The median (IQR) age was 65 (60-70) years in TITAN and 70 (65-80) years in SPARTAN. Patients with statin exposure were older with higher body mass index, while the proportion of patients with ECOG performance status score 1 was relatively lower. Statin exposure was associated with superior OS in patients treated with apalutamide (TITAN: hazard ratio [HR], 0.53; 95% CI, 0.32-0.87; SPARTAN: HR, 0.54; 95% CI, 0.39-0.74), but not in patients who received the placebo (TITAN: HR, 0.65; 95% CI, 0.38-1.13; SPARTAN: HR, 1.16; 95% CI, 0.76-1.77). Covariate-adjusted 3-year OS among patients with vs without statins were 81% vs 67% (difference, 14% [95% CI, 5%-22%]) and 86% vs 78% (difference, 8% [95% CI, 3%-13%]) in the apalutamide-treated patients from TITAN and SPARTAN trials, respectively. Patients receiving statins had a higher risk of grade 3 or higher cardiac AEs in both apalutamide (subdistribution HR, 2.62 [95% CI, 1.35-5.08]) and placebo (subdistribution HR, 2.36 [95% CI, 0.96-5.84]) groups. Conclusions and Relevance: In this cohort study, statin exposure was associated with longer OS in patients treated with apalutamide. Statin-exposed patients had a higher risk of grade 3 or greater cardiac AEs, which may reflect their preexisting cardiovascular comorbidity.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».