摘要
目的 探讨转移性前列腺癌的预后及相关因素。方法 转移性前列腺癌患者32例。平均年龄71（54～87）岁。均经直肠标准6点前列腺穿刺活检证实为前列腺癌，阳性点数1～2点4例、3～4点7例、5～6点21例。Gleason评分2～6分2例、7分19例、8～10分11例。临床分期T1～2cN1M06例、T2cN1M11例、T3aN1M13例、T3aN2M12例、T3bN1M15例、T％N2M11例、T4N1M14例。治疗前血清PSA值63～2000ng／ml，中位数158ng／ml；血清睾酮平均11．4（4．4～50．7）nmol／L。骨转移27例，其中合并盆腔淋巴结转移8例，单纯淋巴结转移5例。采用手术去势加雄激素阻断（比卡鲁胺50mg／d或氟他胺250mg3次／d）治疗。一线内分泌治疗时间7～48个月，中位时间23个月。一线内分泌治疗失败后，改用己烯雌酚或雌二醇氮芥治疗，41％的患者对二线内分泌治疗不敏感，59％的患者对二线治疗有效，持续时间3～15个月。统计学分析患者预后与治疗前各指标的相关性。结果32例患者平均随访33（13～98）个月。28例确诊后13～86个月死亡。存活4例，随访78～98个月。中位生存时阃37个月。1、3、5年存活率分别为100％（32／32）、53％（17／32）、19％（6／32）。患者生存期与治疗前血清PSA（r=-0．262，P=0．045）、Gleason评分（r=0．624，P=0．001）呈负相关，与治疗前睾酮水平（r=0．514，P=0．008）及年龄（r=0．311，P=0．032）呈正相关，与治疗前穿刺活检阳性点数（r=0．211，P=0．158）及临床分期（r=0．058，P=0．352）无关。结论转移性前列腺癌预后与患者术前睾酮水平、年龄、Gleason评分、血清PSA有关，与治疗前穿刺活检阳性点数及临床分期无关。
Objective To discuss the prognosis of the metastatic prostatic carcinoma and analyze the relative factors. Methods From 2001 to 2002, 32 cases of matastatic prostatic carcinoma were admitted to our hospital, the ages ranging from 54 to 87, with the mean age of 71 years. All the diagnosis was proved by the six cores transrectal biopsy of the prostate. The serum PSA ranged from 63 to 2000 ng/ml. Two cases had the Gleason score of 2-6, 19 cases had the Gleason score of 7 and 11 cases had the Gleason score of 8-10. Preoperative routine examinations included serum testosterone, pelvic CT or MRI scan, CXR and bone scan. Twenty-seven cases were found to have osseous metastasis, among them 8 cases comhined with lymph nodes metastasis, and 5 cases with lymph nodes metas tasis only. All of them were treated with gonadectomy and the blockade of the androgen receptor （with Bicalutamide 50 mg/d or Flutamide 250 mg/d）. It lasted 7-48 months with first endocrine therapy,and mid last time 23 months. After first line endocrine therapy failure, Diethylstilbestrol and Estramustine were used in the androgewindependent stage. Thirteen cases were not effective, and sec- ond therapy had effect to 19 cases and it lasted for 3-15 months. Results The follow-up periods ranged from 13 to 98 months, with the mean period of 33 months. Twenty-eight cases died, 4 cases survived. The median survial period was 37 months, 1-year survival rate was 100% （32/32）, 3-year survival rate was 53%（17/32）, 5-year survival rate was 19 % （6/23）. As to the survival period, there were negative correlaions between survival and the level of PSA （r= -0. 262, P=0. 045） and the Gleason score （r= -0. 624, P= 0. 001）. There were positive correlations between survival and the level of testosterone （r=0. 514, P=0. 008） and the age （r=0. 311, P=0. 032）. And there was no correlation between survival and the number of the positive cores of the biopsy （r=0. 211, P=0. 158） and the clinical stage （r=0. 211, P=0. 352）. Conclusions As to the metastatic prostatic carcinoma, there are correlations between the survival and the levels of testosterone before treatment, age, the G1 eason score and the level of PSA. There is no relationship between the survival period of the metastatic prostatic carcinoma and the number of the positive cores of the biopsy and the clinical stage.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2009年第12期838-840,共3页
Chinese Journal of Urology
关键词
前列腺肿瘤
癌
转移性
预后
Prostatic neoplasms
Carcinoma
Metastatic
Prognosis
