前列腺癌内分泌治疗进展至激素难治期危险因素分析

Prognostic factors of progression to hormone-refractory stage after hormone therapy for prostate cancer

目的前列癌发病与病情变化种族地域差异明显,国外相关结果并不完全适用于中国人群。分析45例中国人群前列腺癌内分泌治疗的危险因素。方法以内分泌治疗起始进展至雄激素非依赖期(AIPC)的时间,以及进展至激素难治期(HRPC)的时间为评估目标。选择如下因素:确诊时年龄,基线PSA,Gleason评分,临床分期,有无骨转移,一线治疗过程中PSA达到的最低值(PSAnadir),治疗后达到PSAnadir时间等进行Cox回归分析。结果治疗开始进展至AIPC中位时间为19个月,进展至HRPC中位时间为35个月。临床分期(P=0.016)、骨转移(P=0.049)、Gleason评分(P=0.001)、基线PSA(P=0.04)、PSAnadir(P=0.012)为治疗进展至AIPC期的危险因素,其中临床分期(P=0.025)、Gleason评分(P=0.009)、基线PSA(P=0.012)、PSAnadir(P=0.009)为治疗起始进展至AIPC期的独立危险因素。Gleason评分(P=0.002)、PSAnadir(P=0.009)为治疗进展至HRPC期的危险因素,其中PSAnadir(P=0.038)为独立危险因素。结论国内前列腺癌患者自内分泌治疗起始,进展至AIPC和HRPC的时间分别为19个月与35个月,病情进展危险因素包括Gleason评分、PSAnadir等。

Objective This article analyzed the basic data of hormone therapy of prostate cancer in Chinese people to find the predictive factors which related to the effect of hormone therapy and prognosis. Methods 45 patients who had been underwent hormone therapy was involved, and were consistent with the condition of androgen independent or hormone refractory prostate cancer. We calculate the time it take to progression to AIPC or HRPC stage. Predict factors under evaluation include： age, baseline PSA level, Gleason score, clinical stage, PSA nadir, the time it takes to reach PSA nadir, bone metastasis. SPSS 17.0 was used in analysis. Univariate Cox regression is used to pick out probable predict factors, and then enter multivariate Cox regression. Cumulative survival is analyzed by log rank test and Kaplan-Meier life curve. Results The median time of progression free survival of first-line hormone therapy is 19 months, and the median time after hormone therapy to progression to HRPC stage is 35 months. Cox regression show that the clinical stage, Gleanson score, PSA nadir and baseline PSA level are independent factors that predict the progression free survival time. And PSA nadir is the only independent predict factor that influence the time to progression to HRPC stage. Conclusions The overall progression free survival rate at 1 year, 2 year,3 year is 64% , 43% and 33% respectively. Clinical stage, Gleanson score, PSA nadir and baseline PSA level are independent factors that predict the progression free survival time. And there seen not so much different therapeutic response between Chinese people and foreigners.