抗雄与米非司酮间歇治疗对前列腺癌雄激素抵抗的延缓作用

Therapeutic action of mifepristone in intermittent androgen deprivation therapy on androgen independent prostate cancer

目的探讨前列腺癌雄激素抵抗发生的机制及临床治疗。方法选择42例雄激素敏感性晚期前列腺癌作为治疗对象,进行间歇性雄激素阻断治疗,其中24例间歇期停用所有抗雄药物,雄激素阻断治疗期6~8个月,间歇期4~5个月,另外18例在间歇期应用米非司酮进行治疗,选择同期住院的40例晚期前列腺癌病例行持续性雄激素阻断治疗作为对照。三组病例观察期6年,以最大雄激素阻断失效、PSA持续升高、临床症状逐渐加重作为疾病进展的观察终点。分析三组病例平均治疗期时间、间歇期时间及疾病总的进展时间作为疗效相关判断标准。结果持续治疗组的平均疾病进展时间为（25.5±5.1）个月,间歇治疗组为（26.7±6.9）个月,两组间无明显差别（P〉0.05）,而米非司酮治疗组的平均疾病进展时间为（43.3±8.3）,均明显长于前两组（P〈0.01）。结论间歇性雄激素阻断与持续性雄激素阻断治疗对晚期前列腺癌疗效相似,而在间歇期应用米非司酮治疗有效延缓了前列腺癌雄激素非依赖性的发生。

Objective To evaluate the efficacy of mifepristone in intermittent androgen deprivation therapy on androgen independent prostate cancer. Methods Totally 42 cases of advanced and androgen sensitivity prostate cancer were treated with intermittent androgen deprivation,including 24 cases with androgen deprivation for 6 ~ 8 months and intermittent period for 4 ~ 5 months,the other 18 patients treated with mifepristone in the intermittent period,40 patients advanced prostate cancer underwent continuous androgen deprivation therapy as control. The three groups were observed for6 years,with maximum androgen blockade failure,PSA continues rising,and with aggravation of the clinical symptoms as the disease progression endpoints. The average treatment time,interval time and the total time to progression as the efficacy criteria. Results The average time to disease progression in continuous androgen deprivation group was（ 25. 5± 5. 1） months,（ 26. 7 ± 6. 9） months in intermittent treatment group,with no significant difference between the two groups（ P〈0. 05）,while the average time to disease progression in mifepristone treatment group was（ 43. 3 ± 8. 3）,significantly longer than above two groups（ P〈0. 01）. Conclusion The treatment effect between intermittent androgen blockade and continuous androgen deprivation for advanced prostate cancer is similar,treatment with mifepristone in the intermittent period delays the occurrence of androgen independent prostate.