前列腺癌患者内分泌治疗前全身炎症反应指数在预后评估中的价值

Pretreatment systemic inflammation response index as an independent prognostic indicator for prostate cancer patients treated with maximal androgen blockade

目的探讨前列腺癌患者内分泌治疗前全身炎症反应指数（SIRI）在预后评估中的价值。方法回顾性分析2010年1月至2015年6月收治的以全雄激素阻断治疗为初始治疗方式的351例前列腺癌患者的临床及预后资料。中位年龄76岁（51～89岁）。中位PSA 91.60 ng/ml（0.11～1 000.00 ng/ml）。Gleason评分6分39例，3＋4分47例，4＋3分89例，8分107例，9～10分69例。伴骨转移158例。根据受试者工作特征（ROC）曲线确定SIRI的最佳截断值，并以此将患者分为低SIRI组和高SIRI组，比较两组患者的临床病理特征，并采用Cox回归模型分析影响预后的独立因素。结果本研究351例，中位随访43个月（9～75）个月。疾病进展162例，死亡91例，其中肿瘤特异性死亡75例。ROC曲线确定SIRI＝1.2为最佳截断值，将患者分为低SIRI组（〈1.2）181例和高SIRI组（≥1.2）170例。两组患者治疗前的年龄、Gleason评分和伴骨转移比例的差异均无统计学意义（P〉0.05），但是高SIRI组PSA值高于低SIRI组（100.00 ng/ml与89.11 ng/ml，P＝0.046）。Cox多因素分析结果显示SIRI≥1.2、Gleason评分〉7分和骨转移是影响前列腺癌患者疾病无进展生存、肿瘤特异性生存和总生存的独立危险因素。结论治疗前SIRI≥1.2是行内分泌治疗的前列腺癌患者预后不良的独立影响因素。

ObjectiveTo investigate the efficacy of pretreatment systemic inflammation response index （SIRI） in predicting the prognostic of prostate cancer （PCa） patients treated with maximal androgen blockade （MAB）.MethodsThe data of 351 PCa patients who had undergone MAB as first-line therapy between January 2010 and June 2015, were retrospectively analyzed. The age of patients in our cohort ranged from 51 to 89 years old, mean 76 years old. The median value of PSA was 91.60ng/ml, ranging 0.11-1 000.00 ng/ml. 39 cases had a Gleason score of 6, 47 cases had a score of 3＋ 4, 89 cases had a score of 4＋ 3, 107 cases had a score of 8, and 69 cases had a score of 9-10. 158 cases had bone metastasis. Patients were categorized in two groups using a cut-off point of 1.2 as calculated by the receiver-operating curve analysis. Correlations between SIRI and clinical characteristics were analyzed. Meanwhile, univariate and multivariate cox regression analyses were performed to determine the associations of SIRI with progression-free survival （PFS）, cancer-specific survival （CSS） and overall survival （OS）.ResultsThe median follow-up duration was 43.0 months, ranging 9-75 months. The disease progression occurred in 162 patients, 91 patients died, including 75 who died because of PCa at the end of the last follow-up. The differences of age, Gleason score and incidence of metastasis between low SIRI group （〈1.2） and high SIRI group （≥1.2） were not significant （P〉0.05）. But the patients in high SIRI group had higher PSA （P=0.046）. Multivariate analyses identified SIRI, Gleason score and metastasis as independent prognostic factors for PFS, CSS and OS.ConclusionsPretreatment SIRI≥1.2 was an independent predictor for poor prognosis in PCa patients treated with MAB.