老年前列腺癌内分泌治疗后早期去势抵抗的危险因素分析

Analysis of independent risk factors for early castrate-resistant after endocrine therapy in elderly patients with prostate cancer

目的分析老年前列腺癌患者内分泌治疗后进展为去势抵抗性前列腺癌(CRPC)的独立危险因素。方法纳入2013年7月-2015年7月在福建医科大学附属第二医院泌尿外科接受内分泌治疗的90例老年前列腺癌患者作为研究对象,收集患者基本资料、肿瘤病理学检查结果及实验室相关指标。记录出院后2年内CRPC的发生率;采用Cox风险回归模型分析CRPC的高危因素,采用ROC曲线评估危险因素对CRPC的预测价值,并建立预测老年前列腺癌患者院外2年发生CRPC的指数方程。结果 90例患者平均随访24个月,失访2例,26例发生CRPC,发生率29.55%。Cox风险回归模型分析显示,T分期(OR=3.823,95%CI 2.137~6.839,P<0.001)、Gleason评分(OR=8.045,95%CI 3.501~18.487,P<0.001)、前列腺特异性抗原(PSA)(OR=2.983,95%CI1.407~6.324,P=0.004)及前列腺癌基因3(PCA3)(OR=1.998,95%CI1.263~3.161,P=0.003)是老年前列腺癌患者早期进展至CRPC的独立危险因素。根据多因素分析结果建立预测CRPC模型的指数方程为PI=0.367X1+0.642X2+0.409X3+0.815X4,其ROC曲线下面积(AUC)为0.855(β=0.056,95%CI0.745~0.965,P<0.001),敏感度为0.919,特异度为0.857,约登指数为0.776,对应的预后指数为1.325。结论肿瘤T分期、Gleason评分、PSA及PCA3是老年前列腺癌患者内分泌治疗后进展至CRPC的独立危险因素,综合各因素建立预测CRPC的模型有助于提高判断的准确性。

Objective To analyze the independent risk factors for castrate-resistant prostate cancer(CRPC) after conservative endocrine therapy in elderly prostate cancer patients.Methods Totally 90 elderly prostate cancer patients undergoing endocrine therapy from July 2013 to July 2015 were included into this study as research objects.The basic data and pathological,and laboratory indexes were collected from them.The incidence of CRPC in 2 years after discharge was recorded by follow-up,the Cox risk regression model was used to analyze the high-risk factors of CRPC.The application value of the risk factors to predict CRPC were analyzed by receiver operating characteristic curve and the exponential equation was established to predict the occurrence of CRPC in elderly patients with prostate cancer for 2 years.Results Totally 90 patients were followed up for 24 months in average,of whom 2 cases were lost to follow-up,26 developed CRPC,the incidence of CRPC was 29.55%.The Cox risk regression model showed that T stage(OR=3.823,95%CI 2.137-6.839,P<0.001),Gleason score(OR=8.045,95%CI 3.501-18.487,P<0.001),prostatic specific antigen(PSA)(OR=2.983,95%CI 1.407-6.324,P=0.004) and prostate cancer gene 3(PCA3)(OR=1.998,95%CI1.263-3.161,P=0.003) were the independent risk factors for prostate cancer progressing to early CRPC in elderly prostate cancer patients.The exponential equation for predicting CRPC model was 0.367 X1+0.642 X2+0.409 X3 +0.815 X4 according to the results of multivariate analysis(X1:T stage,X2:Gleason score,X3:PSA value,X4:PCA3 value),the AUC was 0.855(β=0.056,95%CI 0.745-0.965,P<0.001).The sensitivity was 0.919,the specificity 0.857,the Youden index 0.776,and the corresponding index of prognosis1.325.Conclusion The T stage,Gleason score,PSA and PCA3 are independent risk factors for prostate cancer progressing to CRPC after endocrine therapy in elderly prostate cancer patients,can be used comprehensively to establish a model of predicting CRPC for improving the accuracy of judgments.