多西他赛联合泼尼松治疗转移性去势抵抗性前列腺癌的临床分析

Survival analysis of patients with metastatic castration-resistant prostate cancer treated with docetaxel plus prednisone

目的 探讨转移性去势抵抗性前列腺癌（metastatic castration-resistant prostate cancer,mCRPC）患者多西他赛化疗后总生存期（overall survival,OS）的影响因素. 方法 回顾性分析2005年11月至2011年9月接受多西他赛化疗的115例mCRPC患者的临床资料.确诊年龄49～81岁,中位数为65岁.确诊时PSA值2.9～4000.0μg/L,中位数为100.0μg/L.Gleason评分≤7分26例,≥8分89例.化疗时年龄51～82岁,中位数为68岁.化疗前基线PSA值0.8～4066.4μg/L,中位数为90.5μg/L.基线血红蛋白（Hb）浓度68～150 g/L,中位数为121 g/L.基线碱性磷酸酶（alkaline phosphatase,ALP）浓度为33～1083 U/L,中位数为110 U/L.激素敏感时间2～114个月,中位数为23个月.115例均有骨转移,其中16例伴有内脏器官转移.接受多西他赛化疗1～16个周期,平均6个周期.患者均进行随访,对可能影响化疗疗效的因素进行单因素生存分析,并将其中有统计学意义的指标纳入多因素分析.生存函数分析采用Kaplan-Meier法,采用Logrank法进行显著性检验. 结果 本组115例随访2～74个月,中位时间为45个月.87例死亡,28例生存.中位OS为（17.0±1.9）个月.单因素生存分析结果显示,化疗前PSA值、基线Hb浓度、ALP浓度、乳酸脱氢酶（lactate dehydrogenase,LDH）浓度、谷氨酰转肽酶（gamma-glutamyl transpeptidase,GGT）浓度、ECOG评分、激素敏感时间及化疗周期数与OS相关（P＜0.05）.Cox模型多因素分析显示,基线ALP≥110 U/L、Hb＜110 g/L、激素敏感时间＜23个月及化疗周期数＜6个是较短OS的独立预后因素（P＜0.05）. 结论 化疗前基线ALP浓度、Hb浓度、激素敏感时间及化疗周期数是mCRPC患者多西他赛化疗后OS的独立预后因素.

Objective To explore the potential value of patient characteristics in predicting over- all survival （OS） in patients with metastatic castration-resistant prostate cancer （mCRPC） treated with docetaxel plus prednisone. Methods We retrospectively analyzed the data of 115 consecutive Chinese patients with mCRPC received docetaxel chemotherapy in our institution from Nov. 2005 to Sep 2011. The median age at diagnosis was 65 years old and median serum prostate-specific antigen （PSA） level at diagnosis was 100.0μg/L. The Gleason seore≤7 in 26 patients and≥8 in 89 patients. The median age at chemotherapy was 68 years old, ranging from 51 to 82 years old. The median baseline PSA level was 90.5μg/L, ranging from 0.8 to 4066.4 μg/L. The median baseline hemoglobin （Hb） concentration was 121 g/L and median baseline alkaline phosphatase （ALP） concentration was 110 U/L. The time to castration resistance ranged from 2 to 114 months and the median value was 23. All 115 patients have bone metastasis, and 16 cases were simultaneously observed the presence of vis- ceral metastasis including lung （9 cases）, bladder （4 cases）, liver （2 cases） and brain （1 case）. The average cycles of chemotherapy was 6, ranging from 1 to 16. We retrospectively collected the variables including patient characteristics at diagnosis and characteristics before the chemotherapy. All laborato- ry analyses were performed in the same laboratory. Survival analysis was performed using Kaplan- Meier curves, and the differences in overall survival rates were assessed using the log-rank test. Only variables that were statistically significant in the univariate analysis （P ~ 0.05） were included in the multivariate model. Results The follow--up was performed until April 30, 2012, and median fol- low-up time was 45 months, ranging from 2 to 74 months. During the follow-up period, 87 of 115 pa- tients （75.7%） died and 1：he median OS for the entire cohort was 17 months, ranging from 2 to 46 months. The univariate analysis identified a total of 8 statistically significant predictors of OS： baseline serum PSA level, baseline Hb concentration, baseline ALP concentration, baseline lactate dehydro- genase （LDH） concentration, baseline gamma-glutamyl transpeptidase （GGT） concentration, ECOG PS, time to castration resistance and cycles of chemotherapy. Subsequent multivariate analysis re- served baseline ALP≥l10 U/L, baseline Hb〈110 g/L, time to castration resistanceS23 months and cycles of chemotherapy〈6 as independent prognostic factors for shorter OS. Conclusions This ret- rospective analysis has demonstrated that baseline ALP concentration, baseline Hb concentration, time to castration resistance and cycles of chemotherapy could provide independent prognostic informa- tion of OS in Chinese patients with mCRPC treated with docetaxel plus prednisone.