初诊伴有脊柱转移的前列腺癌生存相关因素分析

Analysis of prognostic factors associated with survival in men with prostate cancer accompanied by spinal metastases at first diagnosis

目的:探讨初诊时伴有脊柱转移的前列腺癌患者与生存相关的因素。方法:收集2005年1月至2010年12月天津医科大学肿瘤医院接受内分泌治疗的前列腺癌脊柱转移患者49例,针对患者的碱性磷酸酶(ALP)、治疗前有无骨相关事件(SREs)、Gleason评分、治疗后PSA最低值、激素敏感持续时间、有无化疗行单因素分析,并对存在统计学意义者进行多因素分析。结果:平均随访时间64.1个月,死亡41例,中位生存时间为27个月,1、3、5年生存率分别是81.6%、40.8%、20.4%。单因素分析结果显示,有无联合化疗、ALP水平、治疗前是否出现SRE、Gleason评分、治疗后PSA最低值及激素敏感持续时间与总生存率(OS)有关(P<0.05)。Cox回归模型多因素分析显示,激素敏感持续时间≥19个月及联合化疗是较长生存时间的独立预后因素(P<0.05)。结论:激素敏感持续时间及进展为去势抵抗性前列腺癌(castration resistant prostate cancer,CRPC)后是否联合化疗是前列腺癌脊柱转移患者的预后独立因素。

Objective：Prostate cancer frequently metastasizes to the spine. In this study, we investigate the prognostic factors associated with survival in patients with prostate cancer accompanied by spinal metastases at their preliminary diagnosis. Methods：Clinical data of 49 patients who were diagnosed with spinal metastasis from prostate cancer between January 2005 and December 2010 were analyzed. Variables including alkaline phosphatase （ALP）, previous skeletal-related event, Gleason score, prostate-specific antigen （PSA） nadir, and time to castration resistance were obtained. Moreover, the relationship between these variables and overall survival （OS） was analyzed. Survival analysis was performed by using Kaplan-Meier curves. Furthermore, the differences among the OS rates were assessed by using the log rank test. The variables were statistically significant in the univariate analysis （P〈0.05） and were included in the multivariate model. Results：The average follow-up time was 64.1 months among the 49 patients. By the end of the follow-up, 41 of these patients were dead;the mean survival was 27 months. The 1-, 3-, and 5-year survival rate was 81.6%, 40.8%, and 20.4%, respectively. Univariate analysis identified that 6 variables were statistically significant prognostic factors of OS：with or without chemotherapy, ALP, previous skeletal-related event, Gleason score, PSA nadir, and time to castration resistance. The multivariate analysis showed that the time to castration resistance of ≥19 months and the addition of chemotherapy after disease progression are independent prognostic factors for a high OS. Conclusion：With or without chemotherapy and the time to castration resistance are the independent prognostic factors associated with survival in patients with prostate cancer accompanied by spinal metastases at first diagnosis.