雌激素治疗激素难治性前列腺癌的疗效观察

Clinical study of diethylstilbestrol in hormone refractory prostate cancer

目的观察雌激素治疗激素难治性前列腺癌（HRPC）的临床效果及不良反应。方法收集北京大学泌尿外科研究所32例激素难治性前列腺癌患者资料，治疗经过每天口服己烯雌酚2mg，观察服药后血清前列腺特异抗原（PSA）变化，疾病进展时间，患者总体生存率、疾病特异生存率并观察药物毒副作用。结果29例前列腺癌患者资料完整，平均用药时间（8．6±0．9）个月，PSA反应（PSA降低〉50％）8例（27．5％），PSA稳定（PSA降低〈50％，或PSA增高〈25％）7例（24．1％）；PSA进展（PSA增高〉25％）14例（48．3％）。总体中位疾病进展时间4个月（1—12个月）。PSA反应患者中位疾病进展时间6个月（5—12个月）。总体生存率为48．3％，疾病特异生存率为55．2％。主要不良反应为乳房胀痛硬结10例（34．5％）；深静脉血栓3例（10．3％）。结论每天口服2mg己烯雌酚治疗激素难治性前列腺癌可使27．5％的患者PSA降低〉50％，24．1％患者PSA稳定，中位疾病进展时间4个月，雌激素治疗激素难治性前列腺癌效果肯定。

Objective To summarize the clinical outcome and adverse events of estrogen therapy for hormone refractory prostate cancer. Methods A total of 32 patients with hormone refractory prostate cancer received diethylstilbestrol （DES） 2 mg daily at our institute. The data of PSA （prostate-specific antigen） change, time to progression, overall survival rate, disease-specific survival rate and adverse events were collected and analyzed. Results The data of 29 patients were complete. The mean duration of DES dosing was 8. 6 ±0. 9 months. Among them, 8 （27.5%） patients achieved a PSA response with a 50% decrement of PSA or more. Seven （24. 1% ） patients had a stable level of PSA（50% 〈 PSA 〈 125% ）while 14 of 29 （48.3%） maintained a PSA progression with a 25% increment of PSA or more. The overall median time to progression was 4 （1 -12） months. And the median time to progression was 6 （5 -12） months in the PSA response group. The overall survival rate was 48.3% and disease-specific survival rate 55.2%. The main adverse events were gyneeomastia （ 10/29, 34. 5% ） and deep vein thrombosis （ 3/29, 10. 3% ） . Conclusion When used for the treatment of hormone refractory prostate cancer, dethylstilbestrol at a daily dose of 2 mg can achieve a PSA response in 27. 5% patients and a PSA stability in 24. 1% patients. And the median time to progression is 4 months. Estrogen is efficacious for the patients with hormone refractory prostate cancer.