影响多西他赛联合泼尼松治疗转移性去势抵抗性前列腺癌疗效的因素分析

Predictor analysis of PSA response of docetaxel combined with prednisone in the treatment of metastatic castration resistant prostate cancer

目的：探讨转移性去势抵抗性前列腺癌（metastatic castration resistant prostate cancer,m CRPC）患者接受多西他赛＋泼尼松治疗有效性的影响因素。方法：回顾性分析2010年2月至2015年3月在北京大学第一医院转移性去势抵抗性前列腺癌患者接受多西他赛联合泼尼松治疗有效性的影响因素。研究纳入的多西他赛联合泼尼松治疗的m CRPC患者的临床资料,对相关的临床因素进行单因素分析。结果：共60例患者接受治疗,对其中33例临床资料完整的患者进行分析。化疗有效定义为化疗4个周期后前列腺特异性抗原（prostate specific antigen,PSA）较基线下降≥50%,且影像学改变按照实体肿瘤疗效评价标准（response evaluation criteria in solid tumors,RECIST）无进展。其化疗时中位PSA为153.4μg/L（6.6~9 952.0μg/L）,共20例（60.6%）为治疗有效,单因素分析后发现Gleason评分较低者化疗有效性较差（P=0.034）;化疗时存在淋巴结转移者有效率较高（P=0.032）;内脏转移者共15例,其中12例（80%）患者治疗有效（P=0.041）;化疗时出现贫血的患者（HGB≤120 g/L）共10例,化疗有效者3例（30%,P=0.024）。结论：对于m CRPC患者,初发时Gleason评分≤7、诊断时合并淋巴结转移、内脏转移以及化疗时存在贫血是化疗能否有效的预测因素。

Objective： To investigate the factors that may predict the effectiveness of metastatic castration resistant prostate cancer（ m CRPC） patients who received docetaxel plus prednisone treatment.Methods： We retrospectively collected the clinical data of m CRPC patients who has received docetaxel chemotherapy in Peking University First Hospital between February 2010 and March 2015,and the clinical factors were analyzed using univariate analysis. Results： A total of 60 cases of patients were treated,of whom 33 with complete clinical data were analyzed. PSA responsive was defined as PSA declining ≥50% of baseline and without progression according to RESCIST criteria. The median PSA at chemotherapy was 153. 4 μg / L（ 6. 6- 9 952. 0 μg / L）,and a total of 20 cases（ 60. 6%） were PSA responsive.Univariate analysis found that lower Gleason score（ Gleason scores≤7）（ 25% vs. 72%,P = 0. 034）,the existence of positive Lymph node（ 78% vs. 40%,P = 0. 032）,the existence of visceral metastasis（ 80% vs. 44%,P =0. 041） and baseline blood HGB value≤120 g/L（ 30% vs. 74%,P =0. 024） were associated with chemotherapy effectiveness. Conclusion： High Gleason score,lymph node metastasis,visceral metastasis and normal HGB level may predict PSA response after docetaxel-based chemotherapy.