以骨痛为首发症状的前列腺癌生存预后分析

Prognostic significance of PSA, Gleason score, bone metastases, clinical stage, ALP in patients with bone pain as the first manifestation of prostate cancer

目的回顾性分析以骨痛为首发症状骨转移性前列腺癌患者的临床特点，统计分析年龄、穿刺前前列腺特异抗原（PSA）、Gleason评分、有无转移及骨转移数目、临床分期、碱性磷酸酶等对患者整体生存预后的影响。方法收集2003至2010年51例以骨痛为首发症状的骨转移性前列腺癌患者，均经前列腺穿刺或骨转移瘤病理证实。骨转移通过静脉注射555-925MBq 99mTc—MDP后通过SPECT／CT采集分析证实，部分行骨转移肿瘤切除或骨穿刺病理证实。所有患者均接受最大限度的雄激素阻断的内分泌治疗（手术去势或药物去势联合抗雄激素（氟他胺50mg／d，比卡鲁胺50mg／d）。结果以骨痛为首发症状的前列腺癌发生骨转移率较高，为92．2％（47／51），骨盆、腰椎转移率较高，分别为21．5％、29．0％。中位随访时间为32．1个月，至随访结束有20例患者死亡，中位整体生存期为24．4个月。患者年龄（≥71岁vs．〈71岁）与生存预后存在相关性（23．1个月VS．29．1个月，P=0．0169）：穿刺前PSA值（≤100ng／ml vs．〉100ng／m1）与生存预后无相关性（36．7个月坩．19．4个月，P=0．1797）；Gleason评分（2～6，7，8～10）与整体生存预后有明显的相关性（62．4个月vs．35．1个月w．12．5个月，P=0．0173），骨转移数目（〈6个vs．≥6个）与患者整体生存时间具有相关性（36．1个月vs．4．4个月，P=0．0144）；仅有骨转移及骨转移伴有精囊侵犯、肺、淋巴等转移与患者整体生存有相关性（25．7个月1；S．4．4个月，P=0．0304）；临床分期（≤T2w．≥T3）与患者生存预后具有相关性（62．4个月vs．23．1个月，P=0．0257）；碱性磷酸酶（正常坩．升高）与整体生存期明显相关（37．0个月VS．19．0个月，P=0．0151）。一线治疗生化复发的时间为（17．6±8.3）个月，一线治疗失败后予更换成比卡鲁胺治疗后治疗有效率为54．5％（24／44）。结论对于以骨痛为首发症状的骨转移性前列腺癌患者，年龄、骨转移的数目、脏器、淋巴转移、临床分期、碱性磷酸酶、Gleason评分能预测患者的整体的生存预后（P〈0．05）。MAB是较为有效的治疗方式，一线治疗生化复发后二线内分泌治疗部分患者仍可获益。

Objective To analyze the clinical characteristics of prostate cancer with bone pain as the first clinical manifestation retrospectively, the aim of this study was to evaluate the prognostic significance of the age, initial serum level PSA, Gleason score, bone metastases, clinical stage, ALP in the overall survival in patients with bone pain as the first manifestation of prostate cancer. Methods During the time period from 2003 to 2010, a total of 51 patients with newly diagnosed, histologically confirmed prostate cancer, histological diagnosis was carried through the transrectal ultrasonography guided biopsy and carried on Gleason score assessment. Metastases were confirmed by positive bone scintigraphy with 555-925 MBq 99mTc-MDP using Emission computed Tomography, some of which were identified by pathology of excision of metastatic bone tumor or bone marrow aspiration, all of this patients had been treated by androgen deprivation treatment, probe into the impact of the age, initial serum level PSA, Gleason score, bone metastases, clinical stage, ALP on the overall survival. Results The incidence of the bone pain as the first clinical manifestation of prostate cancer was 92.2% （47/51）, the metastasis of pelvis, lumbar was most common, 21.5%, 29.0% respectively, at a median follow-up of 32.1months, 20 patients had died, the median overall survival after maximal androgen blockade was 24.4 months and was significantly longer if the age was less than 71 years （29.1 months vs. 23.1 months, P：0.0169） and Gleason score （2-6, 7, 8-10） was lower （62.4 months vs. 35.1 months vs. 12.5 months, P=0.0173）, bone metastases was less than 6 sites（36.1 months vs. 4.4 months, P=0.0144） ,only bone metastases（Compared to bone and nodes or organs metastases 23.7 months vs. 4.4 months, P=0.0304）, clinical stage was less than stage T2（62.4 months vs. 22.8 months, P=0.0257）, ALP was in the normal rang （37.0 months vs. 19.0 months, P=0.0151）, it had not demonstrated statistically significant interactions of overall survival with the initial PSA level.Mean time 4-SD to PSA relapse after first-line MAB was （17.6± 8.3） months, of the 44 patients （PSA relapse） treated with second-line MAB, 24 （54.5%） were considered to be responders. Conclusions Gleason score, the presence of bone, lymph nodes and liver, visceral metastases, clinical stage, ALP significantly predict OS in patients with bone pain as the first clinical manifestation. Maximum androgen blockade is an effective treatment, some patients can also benefit from the second-line treatment afier PSA relapse of the first-line hormonal treatment.