前列腺特异性抗原动力学参数对激素难治性前列腺癌化疗疗效的预测作用

PSA kinetic parameters in predicting effect of chemotherapy for hormonal refractory prostate cancer

背景与目的:前列腺特异性抗原(prostate specific antigen,PSA)的动态变化往往反映疾病的预后。本研究旨在探讨PSA倍增时间(PSADT)、速率(PSAV)和最低值(nPSA)对激素难治性前列腺癌(hormonal refractory prostate cancer,HRPC)应用多西他赛/米托蒽醌联合泼尼松化疗疗效的预测作用。方法:回顾性分析68例HRPC化疗患者资料,其中多西他赛组39例,米托蒽醌组29例。统计患者nPSA并计算PSADT和PSAV,比较相关因素与化疗疗效的关系。结果:PSADT≤2个月组与>2个月组的有效率分别为40.0%和78.6%;PSAV≤5.0ng/(ml·mo)组与>5.0ng/(ml·mo)组有效率则为70.6%和41.2%,两参数各自分组比较,差异有显著性(P=0.004和0.028)。nPSA≤0.4ng/ml组与>0.4ng/ml组有效率相比,差异无显著性(P=0.499)。多因素分析显示只有PSADT>2.0个月与较高的有效率有关(P=0.007)。临床分期、Gleason评分、诊断时PSA和化疗开始时PSA对化疗疗效无预测作用。结论:PSADT是HRPC患者应用多西他赛/米托蒽醌联合泼尼松化疗疗效的预测因子,化疗前PSADT>2个月患者化疗有效率高,而PSAV和nPSA对化疗疗效无预测作用。

Background and purpose： Dynamic changes of prostate specific antigen suggest the prognosis of prostate cancer at most times. This study was to explore the predictive values of PSA doubling time（PSADT）, PSA velocity（PSAV）and PSA nadir（nPSA） for the effect of docetaxel/mitoxantrone plus prednisone for hormonal refractory prostate cancer（HRPC）. Methods： Among 68 patients with hormonal refractory prostate cancer, 39 received chemotherapy of docetaxel plus prednisone and 29 were mitoxantrone combined with prednisone, nPSA was collected, PSADT and PSAV were calculated for every patient. Univariated and multivariate analysis were performed for the relationship between aforementioned factors and chemotherapy effect. Results： Effective rates for groups of PSADT≤2 months and 〉2 months were 40.0% and 78.6%, the difference was significant（P=0.004）. Effective rates for groups of PSAV ≤ 5.0 ng（ml·mo） and 〉5.0 ng（ml·mo） were 70.6% and 41.2%, the difference was significant （P=0.028）. However, the difference of effective rates between groups of nPSA ≤0.4 ng/ml and 〉0.4 ng/ml was not significant（P=0.499）. Multivariate analysis revealed that only PSADT〉2 months was associated with higher effective rate（P=0.007）. Clinical stage, Gleason score, PSA at diagnosis and PSA at the beginning of chemotherapy did not predict the effect of chemotherapy. Conclusion： PSADT was a predictor of effect of docetaxel/rnitoxantrone plus prednisone for HRPC. Patients with PSADT〉2 months had higher effective rate. PSAV and nPSA could not predict the effect of chemotherapy.