影响前列腺癌内分泌治疗有效时间的临床因素分析

Analysis of clinical factors impacting on the effective time of endocrine therapy for patients with prostate cancer

目的 评估影响前列腺癌患者内分泌治疗有效时间的临床相关因素.方法 回顾性分析432例诊断为前列腺癌并接受单纯内分泌治疗患者的临床资料.研究终点定义为内分泌治疗失效,即前列腺特异抗原（PSA）从最低值连续2次增加,并超过0.2μg/L.纳入分析的变量包括年龄、临床分期、淋巴转移情况、骨转移情况、Gleason评分、初始PSA水平以及PSA最低值,通过Cox回归模型检测其与内分泌治疗有效时间的相关关系.结果 432例患者发病年龄57 ～88 （73.70±7.28）岁.初始PSA水平10.30～588.10（27.15±75.90）μg/L.内分泌治疗有效时间3～62（27.01±13.10）个月.单因素分析表明,初始PSA水平、临床分期、Gleason评分、PSA最低值、淋巴结转移和骨转移与内分泌治疗有效时间存在显著相关关系（P＜0.01）.多因素分析中,仅Gleason评分与内分泌治疗有效时间存在显著相关关系（P=0.001）.与Ghason评分≤3＋4分相比,≥4＋3分患者的内分泌治疗失效风险增加2.49倍,95％ CI 1.44～4.30.结论 在不同分期的前列腺癌患者中,Gleason评分与内分泌治疗有效时间具有显著的相关性,Gleason评分≥4＋3分患者显示出更短的内分泌治疗有效时间.

Objective To assess the clinical factors impacting on the effective time of endocrine therapy for patients with prostate cancer.Methods The chnical data of 432 patients with prostate cancer who accepted endocrine therapy were analyzed retrospectively.The endpoint of the study was failure of endocrine therapy which was defined as continuous elevation of prostate specific antigen （PSA） from nadir for 2 times and more than 0.2 μg/L.The clinical data such as age,clinical stage,lymph node metastasis,bone metastasis,Gleason score,initial PSA,and PSA nadir were collected and their rehtionship with the effective time of endocrine therapy were further assessed via COX regression model.Results Age of onset was 57-88（73.70 ± 7.28） years.Initial PSA was 10.30-588.10（27.15 ± 75.90） μ g/L.The effective time of endocrine therapy was 3-62 （27.01 ± 13.10） months.Univariate regression analysis showed that initial PSA,clinical stage,Gleason score,PSA nadir,lymph node metastasis,bone metastasis were correlated with the effective time of endocrine therapy （P ＜ 0.01）.Multivariate regression analysis showed that only Gleason score was correlated with the effective time of endocrine therapy（P=0.001）.Compared with patients with Gleason score equal to or less than 3＋4,patients with Gleason score equal to or more than 4＋3 showed 2.49 fold increased risk of therapy failure （OR =2.49,95％ CI 1.44-4.30）.Conclusion Gleason score has close relationship with the effective time of endocrine therapy for patients with prostate cancer,Gleason score equal to or more than 4＋3 is an indicator for poor response to endocrine therapy.