新疆不同民族前列腺癌患者内分泌治疗的预后及影响因素分析

The prognosis and influencing factors of endocrine therapy for prostate cancer in different ethnic groups of Xinjiang

背景与目的:前列腺癌存在种族差异,本文探讨新疆不同民族前列腺癌患者内分泌治疗的预后及影响因素,旨在了解种族差异与前列腺癌预后的关系。方法:回顾性分析228例接受内分泌治疗的前列腺癌患者的临床病理资料,应用Kaplan-Meier法计算生存率,对可能影响患者预后的因素分别进行单因素分析(log-rank检验),应用Cox比例风险模型进行多因素统计分析。结果:228例患者1、3和5年疾病特异性生存率分别为93.2%、68.3%和40.1%;汉族和其他少数民族(维吾尔、哈萨克)患者内分泌治疗的3年疾病特异性生存率分别为73.6%和54.2%(P=0.025);不同内分泌治疗组的3年疾病特异性生存率分别为:最大限度雄激素阻断治疗(maximal androgen blockade,MAB)72.2%、单纯去势或单纯抗雄激素药物治疗组56.3%(P=0.004)。单因素分析的结果显示,患者民族、治疗前ECOG体力状况(EPS)评分、临床分期、Gleason评分、治疗前总前列腺特异抗原(total prostate specific antigen,tPSA)、血清碱性磷酸酶(alkaline phosphatase,ALP)、血红蛋白(hemoglobin,HGB)水平以及MAB治疗均对前列腺癌的生存预后产生重要的影响。多因素分析结果显示,患者民族、治疗前EPS评分、临床分期、Gleason评分、HGB及MAB治疗是影响前列腺癌患者存活的重要因素。结论:接受MAB治疗的患者比单纯去势或抗雄激素治疗生存率高;影响前列腺癌内分泌治疗的预后因素中,民族、临床分期、Gleason评分、治疗前HGB水平、EPS评分及MAB治疗都是重要的独立因素。

Background and purpose：Ethnic disparities exist in prostate cancer（PCa）.The study was aimed to understand the associations between the disparities and PCa patients＇ prognosis,by analyzing the factors that may influence the prognosis of PCa patients,from different ethnic groups in Xinjiang,treated with endocrine therapy.Methods：We retrospectively analyzed the clinicopathological data of 228 cases of PCa received endocrine therapy.Overall survival and disease specific survival rates for patients were analyzed by Kaplan-Meier method,and the factors that may influence the prognosis and survival of PCa patients were analyzed using univariate（log-rank test） and multivariate Cox proportional hazard models.Results：1-,3-and 5-year disease specific survival rates were 93.2%,68.3% and 40.1% for all 228 patients,respectively.Three-year disease specific survival rates were 73.6% and 54.2%（P=0.025） for Han patients and other minorities（Uighur ＋ Kazakh） respectively.Three-year disease specific survival was 72.2% for maximal androgen blockade（MAB）,and 56.3% for castration or antiandrogen monotherapy（P=0.004）.Univariate analysis by log-rank test showed that,nationality,pretreatment ECOG performance state score（EPS score）,stage,Gleason score（GS）,pretreatment total prostate specific antigen（tPSA）,serum alkaline phosphatase（ALP）,hemoglobin（HGB） level and MAB therapy were the important factors that impacted on the survival of PCa patients treated with endocrine therapy.Multivariate analysis by Cox model showed that nationality,pretreatment EPS score,stage,Gleason score,pretreatment HGB level and MAB therapy were the significant independent prognostic factors in PCa patients treated with endocrine therapy.Conclusion：MAB therapy provides longer survival time than castration or antiandrogen monotherapy for PCa patients treated with endocrine therapy.Nationality,stage,Gleason score,pretreatment HGB level,pretreatment EPS score and MAB therapy are significant independent factors influencing survival.