High Tumor Burden Predicts Poor Response to Enzalutamide in Metastatic Castration-Resistant Prostate Cancer Patients
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Population and Selection Criteria
2.2. Definition of Tumor Burden
2.3. Clinical Information Collection and Outcome Measurement
2.4. Statistical Analysis
3. Results
3.1. Patient Demographics
3.2. PSA Response
3.3. Radiological Response
3.4. Progression-Free Survival Duration
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Groups * | All Patients | Low Tumor Burden | High Tumor Burden | p-Value | ||
---|---|---|---|---|---|---|
Patient number (n) | 192 | 88 | 45.8% | 104 | 54.2% | |
Median age (range, years) | 72 (46–94) | 74 (51–94) | 71 (46–90) | 0.065 | ||
Median mPC to mCRPC (range, months) | 14 (0–148.9) | 13.3 (0–148.9) | 14.3 (0–125.9) | 0.955 | ||
Median mCRPC to enzalutamide (range, months) | 4 (0–106.2) | 4 (0–72.1) | 3.9 (0–106.2) | 0.848 | ||
Median PSA at diagnosis | 117.3 (3.2–16,410.5) | 63.4 (3.3–9424.7) | 256.6 (3.2–16,410) | <0.001 | ||
ECOG | 0.278 | |||||
0 | 105 | 53 | 60.2% | 52 | 50.0% | |
1 | 67 | 29 | 33.0% | 38 | 36.5% | |
2 and 3 | 20 | 6 | 6.8% | 14 | 13.5% | |
Gleason sum | 0.724 | |||||
≤6 | 10 | 5 | 5.7% | 5 | 4.8% | |
3 + 4 | 12 | 4 | 4.5% | 8 | 7.7% | |
4 + 3 | 29 | 15 | 17.0% | 14 | 13.5% | |
8~10 | 128 | 57 | 64.8% | 71 | 68.3% | |
Missing | 13 | 7 | 8.0% | 6 | 5.8% | |
Abnormal PSA only | 0.368 | |||||
Yes | 71 | 36 | 40.9% | 35 | 33.7% | |
No | 121 | 52 | 59.1% | 69 | 66.3% | |
Abnormal PSA and DRE | 0.171 | |||||
Yes | 54 | 29 | 33.0% | 25 | 24.0% | |
No | 138 | 59 | 67.0% | 79 | 76.0% | |
LUTS | 0.664 | |||||
Yes | 90 | 43 | 48.9% | 47 | 45.2% | |
No | 102 | 45 | 51.1% | 57 | 54.8% | |
Hematuria | 0.473 | |||||
Yes | 8 | 5 | 5.7% | 3 | 2.9% | |
No | 184 | 83 | 94.3% | 101 | 54.9% | |
Bone pain | 0.007 | |||||
Yes | 28 | 6 | 6.8% | 22 | 21.2% | |
No | 164 | 82 | 93.2% | 82 | 78.9% | |
Other metastasis-related symptoms | 0.064 | |||||
Yes | 5 | 0 | 0.0% | 5 | 4.8% | |
No | 187 | 88 | 100% | 99 | 95.2% | |
Skeletal-related events | 0.03 | |||||
Yes | 25 | 6 | 6.8% | 19 | 18.3% | |
No | 167 | 82 | 93.2% | 85 | 81.7% | |
Prior chemotherapy | 0.005 | |||||
Yes | 62 | 19 | 21.6% | 43 | 41.4% | |
No | 130 | 69 | 78.4% | 61 | 58.7% | |
PSA response | 0.026 | |||||
>80% | 90 | 47 | 53.4% | 43 | 41.3% | |
<80% | 56 | 18 | 20.5% | 38 | 36.5% | |
NA or missing | 46 | 23 | 26.1% | 23 | 22.1% | |
Radiological response | 0.017 | |||||
CR, PR and SD | 109 | 52 | 59.1% | 57 | 54.8% | |
PD | 22 | 4 | 4.5% | 18 | 17.3% | |
NA or missing | 61 | 32 | 36.4% | 29 | 27.9% |
Variables | Case Number | Events | Univariable | Multivariable * | ||||
---|---|---|---|---|---|---|---|---|
OR | Range | p Value | OR | Range | p Value | |||
Age | 146 | 90 | 1.02 | 0.99–1.06 | 0.232 | — | — | — |
Time from mPC to mCRPC (months) | 141 (5 missing) | 87 | 1.01 | 0.99–1.03 | 0.277 | — | — | — |
Time from mCRPC to enzalutamide (range, months) | 141 (5 missing) | 87 | 1.01 | 0.98–1.03 | 0.648 | — | — | — |
PSA before enzalutamide (ng/mL) | ||||||||
<10 | 54 | 35 | 1 | — | — | — | — | — |
10~<50 | 54 | 31 | 0.73 | 0.34–1.59 | 0.43 | — | — | — |
≥50 | 38 | 24 | 0.93 | 0.39–2.21 | 0.87 | — | — | — |
Gleason sum | ||||||||
≤7 | 35 | 24 | 1 | — | — | — | — | — |
8~10 | 100 | 60 | 0.69 | 0.30–1.56 | 0.369 | — | — | — |
Missing | 11 | 6 | 0.55 | 0.14–2.2 | 0.397 | — | — | — |
ECOG | ||||||||
0 | 75 | 46 | 1 | — | — | — | — | — |
1 | 54 | 32 | 0.92 | 0.45–1.87 | 0.812 | — | — | — |
2 and 3 | 17 | 12 | 1.51 | 0.48–4.74 | 0.477 | — | — | — |
Initial presentation | ||||||||
Abnormal PSA only | ||||||||
No | 97 | 59 | 1 | — | — | — | — | — |
Yes | 49 | 31 | 1.11 | 0.55–2.26 | 0.775 | — | — | — |
Abnormal PSA and DRE | ||||||||
No | 104 | 58 | 1 | — | — | — | — | — |
Yes | 42 | 32 | 2.48 | 1.11–5.58 | 0.028 | — | — | — |
LUTS | ||||||||
No | 78 | 46 | 1 | — | — | — | — | — |
Yes | 68 | 44 | 1.28 | 0.65–2.5 | 0.478 | — | — | — |
Hematuria | ||||||||
No | 143 | 89 | 1 | — | — | — | — | — |
Yes | 3 | 1 | 0.30 | 0.03–3.43 | 0.335 | — | — | — |
Bone pain | ||||||||
No | 125 | 77 | 1 | — | — | — | — | — |
Yes | 21 | 13 | 1.01 | 0.39–2.62 | 0.979 | — | — | — |
Other metastasis-related symptoms | ||||||||
No | 142 | 87 | 1 | — | — | — | — | — |
Yes | 4 | 3 | 1.90 | 0.19–18.7 | 0.584 | — | — | — |
Comorbidities | ||||||||
Hypertension | ||||||||
No | 57 | 29 | 1 | — | — | 1 | — | — |
Yes | 89 | 61 | 2.10 | 1.06–4.18 | 0.033 | 3.00 | 1.31–6.84 | 0.009 |
Diabetes mellitus | ||||||||
No | 111 | 66 | 1 | — | — | — | — | — |
Yes | 35 | 24 | 1.49 | 0.66–3.34 | 0.335 | — | — | — |
Heart disease | ||||||||
No | 112 | 68 | 1 | — | — | — | — | — |
Yes | 34 | 22 | 1.19 | 0.53–2.64 | 0.675 | — | — | — |
Liver disease | ||||||||
No | 131 | 84 | 1 | — | — | 1 | — | — |
Yes | 15 | 6 | 0.37 | 0.13–1.11 | 0.077 | 0.44 | 0.12–1.63 | 0.217 |
Renal disease | ||||||||
No | 128 | 78 | 1 | — | — | — | — | — |
Yes | 18 | 12 | 1.28 | 0.45–3.64 | 0.64 | — | — | — |
Symptomatic BPE | ||||||||
No | 92 | 52 | 1 | — | — | 1 | — | — |
Yes | 54 | 38 | 1.83 | 0.89–3.73 | 0.099 | 1.52 | 0.65–3.54 | 0.332 |
Tumor-associated status before enzalutamide | ||||||||
Tumor burden | ||||||||
Low | 65 | 47 | 1 | — | — | 1 | — | — |
High | 81 | 43 | 0.43 | 0.22–0.87 | 0.019 | 0.44 | 0.19–1.0 | 0.05 |
Prior chemotherapy history | ||||||||
No | 101 | 67 | 1 | — | — | 1 | — | — |
Yes | 45 | 23 | 0.53 | 0.26–1.09 | 0.082 | 0.51 | 0.19–1.35 | 0.174 |
Bone pain | ||||||||
No | 120 | 72 | 1 | — | — | — | — | — |
Yes | 26 | 18 | 1.50 | 0.60–3.72 | 0.382 | — | — | — |
Skeletal-related events | ||||||||
No | 130 | 80 | 1 | — | — | — | — | — |
Yes | 16 | 10 | 1.04 | 0.36–3.04 | 0.941 | — | — | — |
Laboratory data before enzalutamide | ||||||||
Hemoglobulin (g/dL) | ||||||||
<12 | 52 | 27 | 1 | — | — | — | — | — |
≥12 | 50 | 35 | 2.16 | 0.96–4.87 | 0.063 | 2.70 | 1.07–6.8 | 0.035 |
Missing | 44 | 28 | 1.62 | 0.71–3.68 | 0.249 | 1.89 | 0.59–6.03 | 0.283 |
Platelet count (k/μL) | ||||||||
<200 | 55 | 39 | 1 | — | — | 1 | — | — |
≥200 | 73 | 41 | 0.53 | 0.25–1.11 | 0.09 | 0.48 | 0.2–1.12 | 0.088 |
Missing | 18 | 10 | 0.51 | 0.17–1.54 | 0.233 | 0.59 | 0.14–2.56 | 0.482 |
LDH (IU/L) | ||||||||
<200 | 18 | 15 | 1 | — | — | 1 | — | — |
≥200 | 18 | 9 | 0.20 | 0.04–0.94 | 0.041 | 0.19 | 0.34–1.04 | 0.055 |
Missing | 110 | 66 | 0.30 | 0.08–1.1 | 0.069 | 0.16 | 0.04–0.69 | 0.014 |
Variables | Case Number | Events | Univariable | Multivariable * | ||||
---|---|---|---|---|---|---|---|---|
OR | Range | p-Value | OR | Range | p-Value | |||
Age | 131 | 109 | 1.01 | 0.96–1.07 | 0.653 | — | — | — |
time from mPC to mCRPC (months) | 128 (3 missing) | 108 | 1.00 | 0.98–1.03 | 0.912 | — | — | — |
Time from mCRPC to enzalutamide (range, months) | 127 (4 missing) | 107 | 0.98 | 0.95–1.01 | 0.206 | — | — | — |
PSA before enzalutamide (ng/mL) | ||||||||
<10 | 48 | 39 | 1 | — | — | — | — | — |
10~<50 | 51 | 44 | 1.45 | 0.49–4.26 | 0.499 | — | — | — |
≥50 | 32 | 26 | 1.00 | 0.32–3.15 | 1 | — | — | — |
Gleason sum | ||||||||
≤7 | 27 | 21 | 1 | — | — | — | — | — |
8~10 | 99 | 83 | 1.48 | 0.52–4.25 | 0.464 | — | — | — |
Missing | 5 | 5 | Drop due to perfect prediction | — | — | — | ||
ECOG | ||||||||
0 | 72 | 61 | 1 | — | — | — | — | — |
1 | 46 | 38 | 0.86 | 0.32–2.32 | 0.761 | — | — | — |
2 and 3 | 13 | 10 | 0.60 | 0.14–2.54 | 0.489 | — | — | — |
Initial presentation | ||||||||
Abnormal PSA only | ||||||||
No | 87 | 74 | 1 | — | — | — | — | — |
Yes | 44 | 35 | 0.68 | 0.27–1.75 | 0.427 | — | — | — |
Abnormal PSA and DRE | ||||||||
No | 91 | 74 | 1 | — | — | — | — | — |
Yes | 40 | 35 | 1.51 | 0.51–4.46 | 0.453 | — | — | — |
LUTS | ||||||||
No | 77 | 63 | 1 | — | — | — | — | — |
Yes | 54 | 46 | 1.28 | 0.5–3.3 | 0.612 | — | — | — |
Hematuria | ||||||||
No | 128 | 108 | 1 | — | — | 1 | — | — |
Yes | 3 | 1 | 0.09 | 0.01–1.07 | 0.057 | 0.21 | 0.01–4.43 | 0.319 |
Bone pain | ||||||||
No | 113 | 94 | 1 | — | — | — | — | — |
Yes | 18 | 15 | 1.01 | 0.26–3.84 | 0.988 | — | — | — |
Other metastasis-related symptoms | ||||||||
No | 128 | 107 | 1 | — | — | — | — | — |
Yes | 3 | 2 | 0.39 | 0.34–4.53 | 0.454 | — | — | — |
Comorbidities | ||||||||
Hypertension | ||||||||
No | 50 | 39 | 1 | — | — | — | — | — |
Yes | 81 | 70 | 1.79 | 0.71–4.52 | 0.214 | — | — | — |
Diabetes mellitus | ||||||||
No | 99 | 84 | 1 | — | — | — | — | — |
Yes | 32 | 25 | 0.64 | 0.23–1.74 | 0.379 | — | — | — |
Heart disease | ||||||||
No | 102 | 85 | 1 | — | — | — | — | — |
Yes | 29 | 24 | 0.96 | 0.32–2.87 | 0.942 | — | — | — |
Liver disease | ||||||||
No | 116 | 96 | 1 | — | — | — | — | — |
Yes | 15 | 13 | 1.35 | 0.28–6.48 | 0.704 | — | — | — |
Renal disease | ||||||||
No | 115 | 95 | 1 | — | — | — | — | — |
Yes | 16 | 14 | 1.47 | 0.31–7.0 | 0.626 | — | — | — |
Symptomatic BPE | ||||||||
No | 79 | 67 | 1 | — | — | — | — | — |
Yes | 52 | 42 | 0.75 | 0.3–1.89 | 0.546 | — | — | — |
Tumor-associated status before enzalutamide | ||||||||
Tumor burden | ||||||||
Low | 50 | 66 | 1 | — | — | 1 | — | — |
High | 81 | 43 | 0.24 | 0.07–0.77 | 0.016 | 0.21 | 0.06–0.77 | 0.018 |
Prior chemotherapy history | ||||||||
No | 86 | 75 | 1 | — | — | 1 | — | — |
Yes | 45 | 34 | 0.45 | 0.18–1.15 | 0.095 | 0.60 | 0.18–2.00 | 0.407 |
Bone pain | ||||||||
No | 109 | 90 | 1 | — | — | — | — | — |
Yes | 22 | 19 | 1.34 | 0.36–4.98 | 0.665 | — | — | — |
Skeletal-related events | ||||||||
No | 113 | 95 | 1 | — | — | — | — | — |
Yes | 18 | 14 | 0.66 | 0.2–2.25 | 0.509 | — | — | — |
Laboratory data before enzalutamide | ||||||||
Hemoglobulin (g/dL) | ||||||||
<12 | 44 | 34 | 1 | — | — | 1 | — | — |
≥12 | 47 | 43 | 3.16 | 0.91–10.7 | 0.07 | 4.14 | 1.04–16.4 | 0.043 |
Missing | 40 | 32 | 1.18 | 0.41–33.5 | 0.761 | 0.56 | 0.13–2.52 | 0.454 |
Segment WBC (%) | ||||||||
<60 | 32 | 26 | 1 | — | — | 1 | — | — |
≥60 | 41 | 29 | 0.56 | 0.18–1.7 | 0.304 | 0.80 | 0.10–6.24 | 0.828 |
Missing | 58 | 54 | 3.12 | 0.81–12.0 | 0.099 | 4.24 | 0.33–54.2 | 0.266 |
Lymphocyte (%) | ||||||||
<30 | 51 | 39 | 1 | — | — | 1 | — | — |
≥30 | 43 | 35 | 1.35 | 0.49–3.68 | 0.562 | 2.07 | 0.27–15.7 | 0.480 |
Missing | 37 | 35 | 5.38 | 1.13–25.8 | 0.035 | 2.34 | 0.24–23.4 | 0.469 |
Variables | Case Number | Failure Events | Univariable | Multivariable | ||||
---|---|---|---|---|---|---|---|---|
HR | Range | p-Value | HR | Range | p-Value | |||
Age | 192 | 89 | 1.00 | 0.98–1.02 | 0.926 | — | — | — |
time from mPC to mCRPC (months) | 181 (11 missing) | 87 | 0.98 | 0.97–1.00 | 0.010 | 0.99 | 0.97–1.00 | 0.058 |
Time from mCRPC to enzalutamide (range, months) | 179 (13 missing) | 86 | 1.00 | 0.98–1.01 | 0.676 | — | — | — |
PSA before enzalutamide (ng/mL) | ||||||||
<10 | 79 | 25 | 1 | — | — | 1 | — | — |
10~<50 | 64 | 35 | 1.99 | 1.19–3.32 | 0.009 | 1.84 | 0.99–3.40 | 0.052 |
≥50 | 49 | 29 | 3.22 | 1.87–5.55 | <0.001 | 2.43 | 1.26–4.67 | 0.008 |
Gleason sum | ||||||||
≤7 | 51 | 18 | 1 | — | — | 1 | — | — |
8~10 | 128 | 66 | 1.60 | 0.95–2.70 | 0.076 | 1.06 | 0.59–1.89 | 0.857 |
Missing | 13 | 5 | 12.6 | 0.47–3.40 | 0.645 | 0.93 | 0.31–2.77 | 0.898 |
ECOG | ||||||||
0 | 105 | 41 | 1 | — | — | 1 | — | — |
1 | 67 | 38 | 2.05 | 1.32–3.20 | 0.001 | 1.05 | 0.59–1.89 | 0.858 |
2, 3 | 20 | 10 | 2.35 | 1.17–4.73 | 0.017 | 1.59 | 0.68–3.77 | 0.287 |
Initial presentation | ||||||||
Abnormal PSA only | ||||||||
No | 121 | 63 | 1 | — | — | — | — | — |
Yes | 71 | 26 | 0.80 | 0.51–1.27 | 0.351 | — | — | — |
Abnormal PSA and DRE | ||||||||
No | 138 | 63 | 1 | — | — | — | — | — |
Yes | 54 | 26 | 0.84 | 0.53–1.34 | 0.466 | — | — | — |
LUTS | ||||||||
No | 102 | 47 | 1 | — | — | — | — | — |
Yes | 90 | 42 | 1.03 | 0.68–1.57 | 0.872 | — | — | — |
Hematuria | ||||||||
No | 184 | 86 | 1 | — | — | — | — | — |
Yes | 8 | 3 | 1.88 | 0.59–6.01 | 0.288 | — | — | — |
Bone pain | ||||||||
No | 164 | 79 | 1 | — | — | — | — | — |
Yes | 28 | 10 | 0.79 | 0.41–1.52 | 0.474 | — | — | — |
Other metastasis-related symptoms | ||||||||
No | 187 | 86 | 1 | — | — | — | — | — |
Yes | 5 | 3 | 1.33 | 0.42–4.22 | 0.624 | — | — | — |
Comorbidities | ||||||||
Hypertension | ||||||||
No | 72 | 38 | 1 | — | — | — | — | — |
Yes | 120 | 51 | 0.72 | 0.47–1.1 | 0.129 | — | — | — |
Diabetes mellitus | ||||||||
No | 146 | 67 | 1 | — | — | — | — | — |
Yes | 46 | 22 | 1.13 | 0.7–1.83 | 0.614 | — | — | — |
Heart disease | ||||||||
No | 143 | 67 | 1 | — | — | — | — | — |
Yes | 49 | 22 | 1.06 | 0.65–1.72 | 0.819 | — | — | — |
Liver disease | ||||||||
No | 170 | 79 | 1 | — | — | — | — | — |
Yes | 22 | 10 | 1.16 | 00.6–2.24 | 0.657 | — | — | — |
Renal disease | ||||||||
No | 171 | 77 | 1 | — | — | — | — | — |
Yes | 21 | 12 | 1.17 | 0.63–2.14 | 0.622 | — | — | — |
Symptomatic BPE | ||||||||
No | 116 | 57 | 1 | — | — | — | — | — |
Yes | 76 | 32 | 0.81 | 0.53–1.25 | 0.339 | — | — | — |
Tumor-associated status before enzalutatmide | ||||||||
Tumor burden | ||||||||
Low | 88 | 32 | 1 | — | — | 1 | — | — |
High | 104 | 57 | 1.91 | 1.24–3.0 | 0.003 | 1.40 | 0.82–2.38 | 0.221 |
Prior chemotherapy history | ||||||||
No | 130 | 50 | 1 | — | — | 1 | — | — |
Yes | 62 | 39 | 2.42 | 1.59–3.7 | <0.001 | 2.23 | 1.13–4.40 | 0.021 |
Bone pain | ||||||||
No | 160 | 71 | 1 | — | — | — | — | — |
Yes | 32 | 18 | 1.41 | 0.84–2.38 | 0.190 | — | — | — |
Skeletal-related events | ||||||||
No | 167 | 75 | 1 | — | — | — | — | — |
Yes | 25 | 14 | 2.01 | 1.13–3.57 | 0.017 | 1.29 | 0.64–2.59 | 0.484 |
Laboratory data before enzalutamide | ||||||||
Hemoglobulin (g/dL) | ||||||||
<12 | 63 | 34 | 1 | — | — | 1 | — | — |
≥12 | 69 | 30 | 0.54 | 0.33–0.88 | 0.014 | 0.61 | 0.32–1.14 | 0.123 |
Missing | 60 | 25 | 0.56 | 0.34–0.95 | 0.030 | 0.67 | 0.31–1.47 | 0.316 |
Segment WBC (%) | ||||||||
<60 | 52 | 20 | 1 | — | — | 1 | — | — |
≥60 | 55 | 35 | 1.86 | 1.07–3.22 | 0.027 | 2.18 | 1.16–4.08 | 0.033 |
Missing | 85 | 34 | 1.22 | 0.7–2.12 | 0.489 | 1.30 | 0.61–2.74 | 0.594 |
Platelet count (k/μL) | ||||||||
<200 | 70 | 25 | 1 | — | — | 1 | — | — |
≥200 | 100 | 52 | 1.65 | 1.02–2.66 | 0.040 | 1.15 | 0.66–1.99 | 0.628 |
Missing | 22 | 12 | 1.47 | 0.74–2.94 | 0.269 | 1.88 | 0.64–5.56 | 0.253 |
Alanine aminotransferase (U/L) | ||||||||
<16 | 79 | 46 | 1 | — | — | 1 | — | — |
≥16 | 88 | 33 | 0.56 | 0.36–0.88 | 0.011 | 0.53 | 0.31–0.92 | 0.023 |
Missing | 25 | 10 | 0.57 | 0.29–1.13 | 0.109 | 0.56 | 0.24–1.29 | 0.172 |
Alkaline phosphatase (U/L) | ||||||||
<100 | 47 | 22 | 1 | — | — | 1 | — | — |
≥100 | 19 | 13 | 2.60 | 1.3–5.2 | 0.007 | 2.18 | 1.00–4.77 | 0.051 |
Missing | 126 | 54 | 1.00 | 0.61–1.64 | 0.999 | 1.51 | 0.77–2.97 | 0.234 |
LDH (IU/L) | ||||||||
<200 | 21 | 8 | 1 | — | — | 1 | — | — |
≥200 | 20 | 17 | 4.38 | 1.89–10.17 | 0.001 | 7.46 | 2.68–20.8 | <0.001 |
Missing | 151 | 64 | 1.37 | 0.66–2.87 | 0.398 | 1.81 | 0.76–4.31 | 0.180 |
Calcium (mmol/L) | ||||||||
<2.3 | 39 | 23 | 1 | — | — | 1 | — | — |
≥2.3 | 56 | 24 | 0.50 | 0.28–0.89 | 0.018 | 0.58 | 0.27–1.24 | 0.162 |
Missing | 97 | 42 | 0.58 | 0.35–0.97 | 0.037 | 1.05 | 0.50–2.21 | 0.900 |
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Hsieh, Y.-T.; Chiang, B.-J.; Wu, C.-C.; Liao, C.-H.; Lin, C.-D.; Chen, C.-H. High Tumor Burden Predicts Poor Response to Enzalutamide in Metastatic Castration-Resistant Prostate Cancer Patients. Cancers 2021, 13, 3966. https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13163966
Hsieh Y-T, Chiang B-J, Wu C-C, Liao C-H, Lin C-D, Chen C-H. High Tumor Burden Predicts Poor Response to Enzalutamide in Metastatic Castration-Resistant Prostate Cancer Patients. Cancers. 2021; 13(16):3966. https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13163966
Chicago/Turabian StyleHsieh, Yu-Ting, Bing-Juin Chiang, Chia-Chang Wu, Chun-Hou Liao, Chia-Da Lin, and Chung-Hsin Chen. 2021. "High Tumor Burden Predicts Poor Response to Enzalutamide in Metastatic Castration-Resistant Prostate Cancer Patients" Cancers 13, no. 16: 3966. https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13163966