摘要
目的探讨前列腺癌患者内分泌治疗后进展为去势抵抗性前列腺癌（CRPC）的危险因素。方法回顾性分析2009年2月至2018年2月我院收治的178例内分泌治疗的前列腺癌患者的临床资料。年龄49-91岁，平均72岁；Gleason评分4-10分，中位值7分；初始PSA值0．16-100．00ng／ml，中位值24．45ng／ml；PSA到达最低值时间0．5-69．0个月，中位值9．0个月；最低PSA值0．003-78．670ng／ml，中位值0．030ng／ml；治疗前血红蛋白64—184g／L，平均值131g／L；治疗前碱性磷酸酶35-734U／L，平均值98U／L；糖尿病患者39例（21．9％）；骨转移或内脏转移者82例（46．1％）。临床分期：T1＋T2期85例（47．8％），rrl＋T。期93例（52．2％）。178例确诊后均予药物去势加抗雄激素药物治疗。采用x。检验、单因素及多因素Cox回归分析CRPC与患者年龄、Gleason评分、初始PSA值、最低PSA值、到达PSA最低值时间、治疗前血红蛋白、治疗前碱性磷酸酶、骨转移或内脏转移、临床T分期、糖尿病史等的相关性。结果本组178例随访时问6-92个月，中位值30个月。内分泌治疗后74例进展为CRPC，进展至CRPC的中位时间为15个月（4-47个月）。X2检验分析结果显示，进展至CRPC的患者与未进展至CRPC的患者比较，在Gleason评分（P〈0．001）、最低PSA值（P〈0．1901）、初始PSA值（JD=0．042）、治疗前碱性磷酸酶（P=0．002）、骨转移或内脏转移（P〈0．001）、临床T分期（P〈0．001）的差异有统计学意义。多因素Cox回归分析结果显示，Gleason评分（OR=6．152，P〈0．001）、最低PSA值（OR=3．022，P：0．004）、PSA到达最低值时间（OR=0．375，P〈0．001）是前列腺癌内分泌治疗后进展为CRPC的独立危险因素。结论Gleason评分、最低PSA值、PSA到达最低值时间是前列腺癌内分泌治疗后进展为CRPC的独立危险因素。前列腺癌患者Gleason评分越高，经内分泌治疗后最低PSA值越高，PSA降至最低值时间越短，则进展为CRPC的可能性越大。
Objective To explore risk factors of the progression to castration-resistant prostate cancer（CRPC） after hormone therapy （HT）. Methods A total of 178 patients with prostate cancer from February 2009 to February 2018 were enrolled to analyze the risk factors of the progression to castration- resistant prostate cancer after androgen deprivation therapy in Fujian Medical University Union Hospital. The mean age was 72 years （ range, 49 -91 years）; the middle Gleason score was 7 （range, 4 -10）; the middle PSA at the initiation of HT was 24.45 ng/ml （ range, 0.16 - 100.0 ng/ml） ; the middle time to PSA nadir was 9 months （ range, 0.5 - 69.0 months） ; the middle PSA nadir after HT was 0.030 ng/ml （ range, 0. 003 -78. 670 ng/ml） ; the mean hemoglobin level was 131 g/L （range, 64 -184 g/L） ; the mean alkaline phosphatase level was 98 U/L （range, 35 -734 U/L） ; 39 patients were diabetes mellitus （21.9%） ; 82 patients were bone metastasis/visceral metastasis（46.1% ） ; 85 patients（47.8% ）were in clinical T1 ＋ T2; 93 patients（52.2% ）were in clinical T3 ＋ T4. We studied the relationship between CRPC and these risk factors including age, Gleason score, PSA at the initiation of HT, PSA nadir after HT, the time to PSA nadir, hemoglobin level, alkaline phosphatase, bone metastasis/visceral metastasis, clinical T stage, diabetes mellitus by χ^2 test , univariate and multivariate Cox regression analysis methods. Results The middle follow-up time was 30 months （ range, 6 -92 months）. There were 74 of 178 patients progressed to CRPC after HT. The median time of progression to CRPC in this cohort was 15 months （range, 4 -47 months）. On χ^2 test analysis, there were statistically significant differences between the progression to CRPC group after HT and the rest group in Gleason score （ P 〈 0. 001 ） , PSA nadir after HT （ P 〈 0. 001 ）, PSA at the initiation of HT （ P = 0. 042 ）, alkaline phosphatase （ P = 0. 002 ）, bone metastasis/visceral metastasis （P 〈 0. 001 ） and clinical T stage （ P 〈 0. 001 ）. Additionally, on multivariate Cox regression analysis, Gleason score （ OR = 6. 152 ,P 〈 0. 001 ） , PSA nadir after HT （ OR = 3. 022, P 〈 0. 004） and the time to PSA nadir （OR =0. 375 ,P 〈0. 001 ） were found to be significantly associated with the rapid progression to CRPC. Conclusions Gleason score, PSA nadir after HT and the time to PSA nadir were significantly associated with the progression to CRPC. Patients with higher PSA nadir or the shorter time to PSA nadir were more likely to progress to CRPC.
作者
江绍钦
李梦强
许恩赐
蔡伟忠
江玮
李永生
郑松
Jiang Shaoqin;Li Mengqiang;Xu Enci;Cai Weizhong;Jiang Wei;Li Yongsheng;Zheng Song(Department of Urology,Fujian Medical University Union Hospital,Fuzhou 350001,China.)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第11期847-851,共5页
Chinese Journal of Urology
关键词
前列腺肿瘤
去势抵抗
内分泌治疗
危险因素
Prostatic neoplasm
Castration-resistant
Hormone therapy
Risk factors
