高危前列腺癌间歇性和持续性内分泌治疗的临床评价

Evaluation of clinical efficacy of high risk prostate cancer with the treatment of continuous and intermittent androgen deprivation

目的比较间歇性和持续性内分泌治疗高危前列腺癌的临床疗效。方法2008年1月至2009年4月收治64例高危前列腺癌患者，其中36例接受戈舍瑞林加比卡鲁胺联合治疗（间歇治疗组），28例接受双钡4睾丸切除加氟他胺治疗（持续治疗组）。分别对两组患者的肿瘤特异性病死率、前歹Ⅱ腺特异抗原（PsA）下降到最低值时间、治疗开始到PSA再次升高时间以及血清睾丸酮浓度、生活质量评分等指标进行比较。结果间歇治疗组和持续治疗组随访时间分男Ⅱ为（28．1±8．7）个月和（26。4±10.3）个月，PSA下降到最低值时间分别为（4.0±3.6）个月和（3．8±2.1）个月，治疗开始到PSA再次升高时间分别为（24.5±14.6）个月和（20.1±12.3）个月，两组比较差异均无统计学意义（P〉0．05）。在治疗第18、24和30个月时，血清睾丸酮浓度持续治疗组分别为0．85、0．88、0．89μg/L，间歇治疗组分别为1．21、1．36、1．48μg/L；在治疗第12、t8、30个月时，生活质量评分持续治疗组分别为38.7、40．5、39。8分，河歌活；宁组分别为49．2、51.4、52．3分。两组血清睾丸酮浓度和生活质量评分在上述各时阀点比较差异均有统计学意义（P〈0.05）。结论间歇性和持续性内分泌治疗在临床疗效方面比较差异无统计学意义，但在间歇期，患者的生活质量随着血清睾丸酮浓度的增加而部分改善。

Objective To compare the clinical efficacy between continuous and intermittent androgen deprivation in high risk prostate cancer. Methods Sixty-four patients with high risk prostate cancer were treated from January 2008 to April 2009,36 cases who accepted goserelin and bicalutamide were taken as intermittent hormonal therapy （intermittent treatment group）, while 28 cases who accepted bilateral orchiectomy in addition to flutamide were regarded as continuous hormonal therapy （continuous treatment group）. The comparison of tumor specific mortality, time of prostate specific antigen （PSA） to nadir, time to PSA recurrence, serum testerone and quality of life score were assessed between the two groups. Results In continuous treatment group and intermittent treatment group, follow-up period was （26.4 ± 10.3） and （28.1 ± 8.7） months,the time of PSA to nadir was （3.8 ±2.1 ） and （4.0 ±3.6） months, the time to PSA recurrence was （20.1 ± 12.3） and （24.5 ± 14.6） months, respectively. There was no significant difference between the two groups. At the time of 18, 24 and 30 months after therapy, serum testerone was 0.85, 0.88, 0.89 μg/L in continuous treatment group,while 1.21, 1.36, 1.48 μg/L in intermittent treatment group,respectively （P 〈 0.05 ）. Similarly, quality of life score was 38.7, 40.5, 39.8 scores in continuous treatment group,while 49.2, 51.4, 52.3 scores in intermittent treatment group at the time of 12, 18 and 30 months after therapy, respectively （P 〈 0.05）. Conclusions Clinical efficacy could not been found between continuous and intermittent endocrinic therapy of prostate cancer. During intermittent, quality of life seems to be better and increases in accordance with serum testerone recurrence at given time.