晚期前列腺癌患者间歇性内分泌治疗的疗效观察

Intermittent hormonal therapy for patients with advanced prostate cancer

背景与目的：间歇性内分泌治疗是晚期前列腺癌患者的一种新的治疗策略，但该方法的运用仍然存在一定争议。该研究旨在探讨晚期前列腺癌患者行间歇性内分泌治疗的疗效，并对影响疗效的因素进行分析。方法：选取2009年7月-2015年5月间在我院治疗的晚期前列腺癌患者，均先进行6个月的内分泌治疗，然后评估内分泌治疗的疗效，采用随机数表法将对内分泌治疗敏感的患者分为持续治疗组和间歇治疗组，观察两组患者的疗效、患者的生活质量评分及不良反应等指标，并分析影响间歇治疗组患者预后的相关因素。结果：共收治晚期前列腺癌患者128例，经前期内分泌治疗后有96例前列腺特异性抗原（prostate—specific antigen，PSA）明显下降，其中43例患者接受间歇性内分泌治疗，53例患者接受持续性内分泌治疗。间歇组患者治疗间歇期的KPS评分为82．6±7．4，明显高于持续组患者治疗期间的KPS评分（69．8±8．7），两者之间差异有统计学意义（P〈0.05）。间歇组患者治疗相关的不良反应发生率、发展成为非激素依赖性的比例均明显低于持续治疗组，差异有统计学意义（P〈0.05）。间歇组5年生存率为72．1％，高于持续组的63％，但两者比较差异无统计学意义（P〉0．05）。前期内分泌治疗后的PSA水平及患者治疗前的Gleason评分是患者预后的重要影响因素。间歇组随访13-70个月，患者接受1—4个循环的治疗。随着治疗时间的延长，参与治疗的例数越来越少，两次治疗的间隔也越来越短。结论：间歇性内分泌治疗是一种有效的治疗晚期前列腺癌的方法，疗效满意，安全可靠，能有效改善患者的生活质量，且能使患者的经济负担明显减轻。

Background and purpose： Although intermittent endocrine therapy is a treatment strategy for new patients with advanced prostate cancer, the use of hormonal therapy is still controversial. This study aimed to investigate the efficacy of intermittent hormonal therapy for the patients with advanced prostate cancer and determine the factors influencing efficacy of the treatment. Methods： From Jul. 2009 to May 2015, patients with advanced prostate cancer were treated with 6 months of hormonal therapy, and then efficacy was assessed. A hundred and twenty-eight hormone sensitive patients were randomly divided into intermittent and continuous treatment groups, and were observed with efficacy, side effects, quality of life scores and other indicators. The prognostic factors for intermittent group were analyzed. Results： A total of 128 patients with advanced prostate cancer were enrolled in the study. Prostate-specific antigen （PSA） levels were significantly decreased in 96 patients after endocrine therapy. Among those, 43 patients received intermittent endocrine therapy while 53 patients received continuous endocrine therapy. The score of KPS in the intermittent treatment group was 82.6 ± 7.4, which was significantly higher than that of the continuous group （KPS score was 69.8 ± 8.7）. There was a significant difference between them （P〈0.05）. The incidence of treatment related side effects and the proportion of developing hormone independent tumor in the intermittent group were significantly lower than that in the continuous treatment group （P〈0.05）. The 5-year survival rate in intermittent group was 72.1%, higher than that in the continuous group （63%）. However, the difference was not statistically significant （P〉0.5）. PSA level in the early stage of endocrine therapy and Gleason score before treatment were important factors affecting the prognosis of patients. The patients in the intermittent group were followed up for 13-70 months, and received 1 to 4 cycles of treatment. The number of patients in the treatment was declined during the extension of the treatment, and the treatment interval was shorter. Conclusion： Intermittent endocrine therapy is an effective treatment for advanced prostate cancer. It is safe and reliable. It can improve the quality of life for patients and reduce the economic burden on them.