化疗前血清乳酸脱氢酶对去势难治性前列腺癌预后预测价值

Pre-chemotherapy lactate dehydrogenase as a prognostic predictor after docetaxel chemotherapy of castration resistant prostate cancer

目的探讨化疗前血清乳酸脱氢酶(lactate dehydrogenase,LDH)对去势难治性前列腺癌(castration-resistant prostate cancer,CRPC)预后的预测价值。方法回顾性分析2008-01-01-2012-01-01天津医科大学肿瘤医院收治的58例单独使用多西他赛方案化疗CRPC患者的临床资料,根据化疗前LDH水平将所有患者分为高LDH组(LDH>248U/L)和低LDH组(LDH≤248 U/L),比较两组患者的临床病理特点,分析LDH对患者预后的影响。结果58例CRPC患者中,高LDH者28例(48.3%),低LDH者30例(51.7%)。两组中位生存期分别为12和27个月,差异有统计学意义,P<0.001。诊断时TNM分期(χ2=10.035,P=0.002)、Gleason评分(χ2=10.008,P=0.002)、ECOG评分(χ2=5.584,P=0.018)、内脏转移(χ2=13.114,P<0.001)、基线PSA(χ2=5.493,P=0.019)、化疗周期数(χ2=9.501,P=0.002)、PSA反应(χ2=17.215,P<0.001)和基线LDH(χ2=28.394,P<0.001)与CRPC患者预后相关。多因素分析显示,诊断时TNM分期、Gleason评分,化疗前是否内脏转移、化疗周期数、PSA反应和基线LDH是影响患者的独立预后因素,P值均<0.05。结论化疗前高LDH者预后差,化疗前高LDH是CRPC患者的独立预后因素。

OBJECTIVE To evaluate the prognostic value of pre-chemotherapy lactate dehydrogenase（LDH）for castration resistant prostate cancer（CRPC）.METHODS A total of 58 CRPC patients who underwent docetaxel？chemotherapy in Tianjin Medical University Cancer Institute and Hospital between January 2008 and January 2012 were enrolled.The patients were categorized into 2groups according to the LDH level before chemotherapy：a high LDH（248U/L）and a low LDH group（≤248U/L）.We compared their clinicopathologic characteristics and analyzed the prognostic value of pre-chemotherapy LDH.RESULTS There were 58 CRPC patients,including high LDH group 28 cases and high LDH group 30 cases,the median overall survival were 12 and 27 months,separately,P〈0.05.TNM stage,Gleason score,ECOG score,visceral metastasis,prechemotherapy baseline PSA,the number of chemotherapy cycles and without remission during chemotherapy were associated with the poor prognosis.Multivariate analysis showed that：ATNM stage,Gleason score,visceral metastasis,the number of cycles of chemotherapy,PSA response and LDH level in patients with CRPC were independent risk factors for prognosis in the CRPC treated with docetaxel-based chemotherapy（P〈0.05）.CONCLUSION Our study showed that patients with high LDH level had poor prognosis,and preChemotherapy lactate dehydrogenase should be an important independent prognostic factor for patients with CRPC.