晚期前列腺癌内分泌治疗药物的疗效观察

Efficacy and safety of diffirent hormonal therapy regiments in advanced prostate cancer patients

目的观察比较晚期前列腺癌内分泌治疗中比卡鲁胺与氟他胺的药物疗效及不良作用情况。方法回顾分析行内分泌治疗的晚期前列腺癌患者136例，其中黄体生成素释放激素类似物（LHRHa）联用比卡鲁胺间歇性内分泌治疗52例（A组）；行LHRHa联用氟他胺间歇性内分泌治疗60例（B组）；单纯行睾丸切除24例（C组）。分析比较3组患者在临床症状、血清PSA值、疾病进展风险、生存率、药物不良反应等方面的差异。结果A、B组症状缓解率分别为80．8％（42／52）和81．7％（49／60），高于C组的70．8％（17／24）；A、B组PSA平均值分别由治疗前的133．3（17．9～982．8）、142．6（20．2～1001．0）ng／ml下降到15．8（0．02～28．9）、16．1（0．07～53．8）ng／ml，较C组由治疗前的142．3（27．1～988．O）ng／ml下降到27．6（6．0～62．1）ng／ml下降得更多；A、B组生化复发率分别为34．6％（18／52）和36．7％（22／60），低于C组的58．3％（14／24）；A、B组平均生化复发时间为22（5～52）和22（6～65）个月，长于C组的11（5～54）个月；A、B组病死率分别为26．9％（14／52）和31．7％（19／60），低于C组的66．7％（16／24）。服用比卡鲁胺组持续用药的患者占88．5％（46／52），服用氟他胺组持续用药者占66．7％（40／60）。比卡鲁胺组药物不良反应发生率低于氟他胺组。结论氟他胺和比卡鲁胺均可以有效治疗前列腺癌，降低治疗前列腺癌进展的风险；比卡鲁胺治疗前列腺癌更安全、有效，值得临床推广。

Objective To compare the efficacy, toxicitis and side-effects of Casodex and Flutamide in the hormonal therapy of advanced prostate cancer patients. Methods One hundred and thirty-six advanced prostate cancer patients were treated with with hormonal therapy. The patients were divided into 3 groups, of which 52 patients（group A） used LHRHa and Casodex as intermittent hormonal therapy; 60 patients（group B） used LHRHa and Flutamide as intermittent hormonal therapy; 24 patients（group C） were treated with surgical castration only. The difference of clinical symptoms, serum PSA, disease progression risk, survival rate, toxicitis and side-effects of 3 groups were compared. Results The relief rates of group A and B were 80.8%（42/52）and 81.7%（49/60） respectively, higher than 70.8% （17/24）of group C. The mean serum PSA of group A and B decreased from 133.3 ng/ml（17.9-982.8 ng/ml） to 15.8 ng/ml（0. 02-28.9 ng/ml）, 142.6 ng/ml （20.2-1001.0 ng/ml）to 16. 1 ng/ml（0.07-53.8 ng/ml）, respectively, both better than that of group C, which decreased from 142.3 ng/ml（27.1-988.0 ng/ml）to 27.6 ng/ml（6.0-62.1 ng/ml）. The mean chemical recurrence rates of group A and B were 34.7% （18/52） and 36.7% （22/60）, respectively, lower than 58. 3% （14/24）of group C. The mean chemical recurrence time of group A and B was 22（5 -52）months and 22（6- 65） months, respectively, longer than 11 （5 - 54） months of group C. The mortality rates of group A and B were 26.9% （14/52） and 31.7% （19/60）, respectively, lower than 66.7% （16/24） of group C. 88. 5 % （46/52）of group A Were treated continuously, while group B had 66.7%（40/60）. The side-effects rate of group A was lower than group B. Conehtsions Both Cadosex and Flutamide are effective for prostate cancer, and decrease the disease progression risk. Casodex is more effective and safer as for the treatment of prostate cancer compared to Flutamide.