医学
前列腺癌
危险系数
内科学
肿瘤科
临床终点
代理终结点
泌尿科
随机对照试验
癌症
置信区间
无进展生存期
总体生存率
作者
L.A. Gharzai,Ralph Jiang,E Jaworski,Krystal Morales,Robert T. Dess,W. Clay Jackson,Holly Hartman,Rohit Mehra,Amar U. Kishan,Abhishek A. Solanki,Edward M. Schaeffer,Felix Y. Feng,Nicholas G. Zaorsky,Alejandro Berlin,Lee Ponsky,Jonathan Shoag,Yilun Sun,Matthew J. Schipper,Jorge A. Garcia,Daniel E. Spratt
出处
期刊:NEJM evidence
[New England Journal of Medicine]
日期:2023-03-28
卷期号:2 (4)
标识
DOI:10.1056/evidoa2200195
摘要
BackgroundThe Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) working group identified metastasis-free survival as a valid surrogate end point for overall survival (OS) for patients with localized prostate cancer. No comparably validated surrogate end points exist in advanced prostate cancer.MethodsWe searched for trials in advanced prostate cancer, defined as node-positive, metastatic castration-sensitive, nonmetastatic, or metastatic castration-resistant prostate cancer. Eligible randomized trials reported OS and one or more intermediate clinical end points, including biochemical failure (BF), clinical failure, biochemical failure–free survival (BFS), progression-free survival (PFS), and radiographic PFS. Candidacy for surrogacy was assessed by using the second condition of the meta-analytic approach; R2 was weighted by the inverse variance of the log intermediate clinical end point hazard ratio and defined as R2>0.70.ResultsA total of 143 randomized trials (n=75,601 patients) were included. No candidate end points met the criteria for surrogacy (R2 BF [n=28,922], 0.42 [95% confidence interval (CI), 0.18 to 0.64]; BFS [n=25,741], 0.57 [95% CI, 0.37 to 0.73]; clinical failure [n=22,616], 0.31 [95% CI, 0.075 to 0.56]; PFS [n=52,639], 0.50 [95% CI, 0.35 to 0.63]; and radiographic PFS [n=52,548], 0.50 [95% CI, 0.35 to 0.63]). Within preplanned subgroups according to castration-sensitive or castration-resistant disease or according to treatment type, neither BFS nor PFS consistently met criteria for surrogacy. Sensitivity analyses showed that candidacy for surrogacy of all end points tested did not change over time.ConclusionsOur aggregate screening method for surrogate end points in advanced prostate cancer showed that commonly used clinical end points are not clear valid surrogate end points for OS. (Funded by the Prostate Cancer Foundation and the National Cancer Institute.)