陕西地区阿比特龙治疗去势抵抗型前列腺癌早期疗效及安全性的初步分析

Preliminary analysis of early clinical efficacy and safety of abiraterone treatment for castration-resistant prostate cancer in Shaanxi area

目的分析陕西地区确诊为去势抵抗型前列腺癌(CRPC)患者行阿比特龙治疗的早期疗效及安全性,为后续治疗提供经验。方法纳入2015年12月至2016年9月陕西省西安市内五家大型三甲医院泌尿外科共计50例CRPC患者,选择使用阿比特龙联合强的松治疗,长期随访并记录治疗期间特异性前列腺抗原(PSA)、睾酮水来变化情况,每3个月复查全身骨显像、盆腔CT或MRI资料,观察并记录药物副作用,分析其中用药12周以上的30例有效病例的临床资料。结果按照PSA工作组(PSAWG)标准,30例患者PSA总体缓解率76%;按是否曾行多西他赛化疗分类,化疗失败后使用阿比特龙PSA缓解率为67%,未行化疗患者PSA缓解率达80%;按患者年龄分类,60~<70、70~80、>80岁PSA缓解率分别为85%、90%和61%;按患者PSA值分类,4~<10、10~80、>80ng/mL以上PSA缓解率分别为100%、66%和75%。阿比特龙总体耐受性良好,在我省以腹泻、水肿、低钾、肝损害常见,30例患者中3例患者出现轻度水肿,3例患者出现一过性肝功异常,1例患者出现罕见的横纹肌溶解和急性肾功损害,药物治疗后均恢复。结论陕西地区CRPC患者口服阿比特龙治疗早期疗效确切,安全性较高,可作为CRPC治疗的推荐方案之一。

Objeotive To analyze the early efficacy and safety of abiraterone treatment for the patients who were diagnosed as castration resistant prostate cancer （CRPC）, and provide initial experience for further treatment. Methods A total of 50 cases of CRPC patients from the Department of Urology in five large hospitals in Xi＇an, Shaanxi province from December 2015^th to September 2016^th were treated with abiraterone plus prednisone and long-term follow-up. During the treatment, PSA, testosterone, bone scanning, pelvic CT or MRI data as well as side effects of drugs were recorded. The clinical data of 30 eligible cases for at least 12 weeks treatment were analyzed. Results According to the PSAWG standard, the PSA response rate of these 30 cases was 76 %. For the patients with or without docetaxel chemotherapy, the PSA response rate was 67 % and 80%, respectively. For the patients aged 60-70, 70-80 and more than 80 years old, the PSA rcsponse rate was 85%, 90% and 61%, respectively. For the patients with PSA valued 4-10 ng/mL, 10-80 ng/mL and more than 80 ng/mL, the PSA response rate was 100%, 66% and 75%, respectively. In general, abiraterone was tolerant. The diarrhea, edema, hypokalemia and liver function damage were common. Among 30 cases of patients, 3 patients had mild edema, 3 patients had abnormal liver function, 1 patient had rhabdomyolysis and acute renal injury, and all patients recovered after drug treatment. Conolusions The abiraterone treatment for CRPC patients in Shaanxi area showed a good early efficacy and high safety, and should be recommended in clinic.