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  • Sutera, Philip; Deek, Matthew P; Van der Eecken, Kim; Shetty, Amol C; Chang, Jin Hee; Hodges, Theresa; Song, Yang; Verbeke, Sofie; Van Dorpe, Jo; Fonteyne, Valérie; De Laere, Bram; Mishra, Mark; Rana, Zaker; Molitoris, Jason; Ferris, Matthew; Ross, Ashley; Schaeffer, Edward; Roberts, Nicholas; Song, Daniel Y; DeWeese, Theodore; Pienta, Kenneth J; Antonarakis, Emmanuel S; Ost, Piet; Tran, Phuoc T

    International journal of radiation oncology, biology, physics, 04/2023, Letnik: 115, Številka: 5
    Journal Article

    WNT signaling is a cellular pathway that has been implicated in the development and progression of prostate cancer. Oligometastatic castration-sensitive prostate cancer (omCSPC) represents a unique state of disease in which metastasis-directed therapy (MDT) has demonstrated improvement in progression-free survival. Herein, we investigate the clinical implications of genomic alterations in the WNT signaling cascade in men with omCSPC. We performed an international multi-institutional retrospective study of 277 men with metachronous omCSPC who underwent targeted DNA sequencing of their primary/metastatic tumor. Patients were classified by presence or absence of pathogenic WNT pathway mutations (in the genes APC, RNF43, and CTNNB1). Pearson χ and Mann-Whitney U tests were used to determine differences in clinical factors between genomic strata. Kaplan-Meier survival curves were generated for radiographic progression-free survival and overall survival, stratified according to WNT pathway mutation status. A pathogenic WNT pathway mutation was detected in 11.2% of patients. Patients with WNT pathway mutations were more likely to have visceral metastases (22.6% vs 2.8%; P < .01) and less likely to have regional lymph node metastases (29.0% vs 50.4%; P = .02). At time of oligometastasis, these patients were treated with MDT alone (33.9%), MDT + limited course of systemic therapy (20.6%), systemic therapy alone (22.4%), or observation (defined as no treatment for ≥6 months after metastatic diagnosis). Multivariable cox regression demonstrated WNT pathway mutations associated with significantly worse overall survival (hazard ratio, 3.87; 95% confidence interval, 1.25-12.00). Somatic WNT pathway alterations are present in approximately 11% of patients with omCSPC and are associated with an increased likelihood of visceral metastases. Although these patients have a worse natural history, they may benefit from MDT.