局部进展期前列腺癌内分泌治疗的临床研究

The significance of clinical study of endocrine therapy for locally advanced prostate cancer

目的 探讨局部进展期前列腺癌内分泌治疗的治疗方法.方法 总结研究自2006年11月～2012年10月在本院泌尿外科诊断为局部进展期前列腺癌而行内分泌治疗的52例患者的病例资料,其中实验组（IAD组）27例采用间歇性雄激素阻断治疗,对照组（CAD组）25例均给予持续性雄激素阻断治疗,根据生活质量调查量表EORTC QLQ-PR25（见附录）记录生存质量数据,比较两组患者的临床症状缓解情况、前列腺癌进展时间、患者生活质量及副反应的发生情况.结果 IAD组患者平均随访（41.4±1.2）个月,CAD组患者平均随访（37.2±2.5）个月,IAD组患者的中位生存期35.6个月,CAD组患者的中位生存期为30.2个月,两组间无进展生存率差异具有显著性（P＜0.05）;在IAD组,患者的尿路症状、治疗相关症状及性功能情况比CAD组有较好的生活质量（P＜0.05）,而两组患者肠道症状无明显差异（P ＞0.05）;IAD组27例患者发生潮热症状者7例（25.9％）、乳房胀痛者4例（14.8％）;CAD组25例患者发生潮热症状者13例（52.0％）、乳房胀痛者11例（44.0％）,比较两组潮热症状及乳房胀痛发生率均有显著性差异（P＜0.5）.结论 间歇性雄激素阻断治疗较之持续性雄激素阻断治疗可减轻雄激素阻断造成的副作用,提高患者的生活质量,降低用药剂量及治疗费用,延缓进展至非激素依赖性前列腺癌的时间,是治疗局部进展期前列腺癌的有效的内分泌治疗方式.

Objectives In order to discuss the differentiation between intermittent androgen deprivation and continuous androgen deprivation for the hormonal therapy of locally advanced prostate cancer.Methods We retrospectively reviewed 52 consecutive patients with a diagnosis of locally advanced prostate cancer in urology department of our Hospital between November 2006 and October 2012.All the patients were performed with androgen-deprivation therapy,Of them,an intermittent androgen deprivation（IAD） was performed in 27 cases and continuous androgen deprivation（CAD） in 25,Patients＇ quality of life also was measured by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire PR25（EORTC QLQ-PR25）,Compared clinical symptom、the time to prostate cancer progression 、quality of life and side effects between the two groups.Results The mean follow-up period was（41.4 ± 1.2）monthsin group IAD and （37.2 ±2.5）monthsin group CAD.The median time to disease progression was 35.6 months in group IAD and 30.2 months in group CAD,respectively.there was a significant difference between group IAD and CAD in the progression-free survival rate（P ＜0.05）.The average expense of IAD and CAD is7809 ±504yuan and 9927 ±865 yuan respectively（P ＜0.05）.During the treatment period,QOL scores of the patient in group IAD reflected improvement in urinary symptoms,treatment-related symptoms and sexual function betterthan the group CAD（P ＜0.05）,two groups of patients with bowel symptoms was no significant difference（P ＞0.05） ;the IAD group of 27 patients with hot flashes in 7 cases（25.9％）,4 cases of breast tenderness（14.8％） ;the CAD group of 25 patients with hot flashes in 13 cases（52.0％）,breast tenderness in 11 cases （44.0％）,two groups were compared the incidence of hot flashes and breast tenderness significant difference （P ＜0.05）.Conclusions IAD therapy can minimize the side effects of androgen deprivation therapy while maximize the clinical benefits and patients＇ quality of life,decrease the doses,prolonging the time to androgen-independent prostate cancer than CAD therapy,IAD therapy is an effective approach for the therapy in treating locally advanced prostate cancer.