115例前列腺癌骨转移临床特征与预后因素分析

Clinical features and prognostic factors of patients with bone metastases from prostate cancer

目的研究前列腺癌骨转移患者的临床特征及相关预后因素。方法搜集1997—2007年间诊治的115例前列腺癌骨转移患者进行回顾性分析。对患者年龄、诊断原发灶时Gleason评分、诊断原发灶时临床分期、是否内分泌治疗、是否行去势术、原发灶是否放疗、骨转移灶数目、骨转移时PSA和ALP水平、有无周围器官侵犯、有无区域和非区域淋巴结转移、是否伴骨旁软组织侵犯及其他脏器转移进行单因素和多因素预后分析。生存率计算运用Kaplan—Meier法，单因素分析采用Logrank法，多因素分析采用Cox回归模型。结果随访率为100％，1、3、5年随访例数分别为103、79、55例。1、3、5年生存率分别为89．1％、60．9％、49．8％，中位生存期为48．5个月。单因素分析结果显示患者年龄（x^2=7．18，P=0．028）、诊断原发灶时Gleason评分（x^2=8．58，P=0．014）、诊断原发灶时临床分期（X^2=10．62，P=0．014）、骨转移灶数目（x^2=6．87，P=0．009）、骨转移时ALP水平（x^2=8．95，P=0．011）、有无周围器官侵犯（X^2=9．03，P=0．003）和有无非区域淋巴结转移（x^2=12．45，P=0．000）的生存率有差异，余各项无差异。Cox模型多因素分析显示骨转移时ALP水平（x^2=4．08，P=0．020）、诊断原发灶时Gleason评分（x^2=4．57，P=0．044）和是否有非区域淋巴结转移（x^2=3．93，P=0．030）是影响预后的因素。结论前列腺癌骨转移患者生存期较长，而骨转移时ALP水平、诊断原发灶时Glason评分和是否有非区域淋巴结转移与预后有关。

Objective To identify clinical features and prognostic factors in prostate cancer patients with bone metastases. Methods Between 1997 and 2007, 115 prostate cancer patients with bone metastases were retrospectively analyzed. The prognostic factors were analyzed by univariate analysis and multivariate analysis,induding age, Gleason＇s score, stage at diagnosis, hormonal therapy, orchiectomy, radiotherapy, number of bone metastases, level of PSA and ALP, surrounding organ invasion, regional and distant lymph node metastases, soft tissue involvement and other visceral metastases. Survival was calculated by Kaplan-Meier method. Univariate and multivariate analysis were estimated by Log-rank test and Cox regression model. Results The follow-up rate was 100%, and the follow-up number at 1-,3- and 5-year was 103,79 and 55, respectively. The 1-, 3- and 5-year survival rates were 89.1%, 60.9% and 49.8%, with a median survival of 48.5 months. In univariate analysis, the age （ X^2 = 7.18, P = 0.028 ）, Gleason＇s score （ X^2 = 8.58 ,P =0.014） , stage （ X^2 = 10.62 ,P =0. 014） , number of bone lesions （ X^2 = 6.87 ,P =0.009）, ALP level （ X^2 = 8.95,P = 0.011 ）, normal organ invaded （ X^2 = 9.03, P = 0. 003 ） and distant lymph node metastases （X^2 = 12.45 ,P = 0.000） were prognostic factors. In multivariate analysis, the ALP level （X^2 = 4.08, P = 0.020） , Gleason＇s score （ X^2 = 4.57, P = 0. 044 ） and distant lymph node metastases （ X^2 = 3.93, P = 0. 030） were independent prognostic factors. Conclusions Long term survival can be achieved in prostate cancer patents with bone metastases. The number of bone lesions, ALP level, Gleason＇s score, age and distant lymph node metastases are prognostic factors.