血清神经内分泌化标志物对去势抵抗性前列腺癌预后价值研究

Prognostic value of serum neuroendocrine markers among castrated resistant prostate cancer patients

目的探讨血清神经内分泌化标志物嗜铬粒蛋白A(CgA)和神经元烯醇化酶(NSE)对接受阿比特龙治疗的去势抵抗性前列腺癌(CRPC)患者预后的影响。方法回顾分析初次接受阿比特龙联合泼尼松治疗的CRPC确诊患者病例资料,分析血清CgA和NSE水平与CRPC患者临床资料及预后关系,采用单因素和多因素Cox回归分析血清CgA和NSE水平与CRPC患者无进展生存期(PFS)和总生存期(OS)的相关性。结果纳入研究CRPC患者54例,治疗前CgA水平为(112.54±31.94)ng/ml,NSE水平为(14.69±2.43)ng/ml。相关性分析结果显示,CgA与NSE无明显相关性(r=0.115,P=0.406)。治疗前血清CgA和NSE水平与TNM分期、Gleason评分、内分泌治疗时间、是否有远处转移均有关(P值均<0.05)。生存分析结果显示,高CgA组和高NSE组无进展生存期和总生存期均明显低于低CgA组(χ~2值分别为6.233、8.669,P值均<0.05)和低NSE组(χ~2值分别为5.763、7.388,P值均<0.05)。Cox回归分析结果显示,远处转移和高CgA、NSE水平是CRPC患者无进展生存期的危险因素,高CgA和NSE水平是总生存期的危险因素(P值均<0.05)。结论治疗前血清CgA和NSE水平是接受阿比特龙治疗CRPC患者生存期的影响因素,水平越高提示预后不良风险越高,可作为预后评价的有效指标。

Objective To investigate the effect of serum neuroendocrine markers such as pheochromogranin a(CgA)and neuron specific enolase(NSE)on the prognosis of castration resistant prostate cancer(CRPC)patients treated by abiraterone.Methods The clinical data and prognosis of confirmed CRPC patients by prednisone and abiraterone combined treatment for first time were subjected to retrospective study.The correlation between serum CgA,NSE levels and clinical data together with prognosis were analyzed.The correlation between serum CgA and NSE levels with progression free survival(PFS)and total survival(OS)was analyzed by single factor and multivariate Cox regression analysis.Results A total of 54 CRPC patients were included in the study.The CgA level was(112.54 ± 31.94)ng/ml and NSE level was(14.69 ± 2.43)ng/ml before treatment.There was no significant correlation between CgA and NSE levels(r=0.115,P=0.406).The levels of CgA and NSE before treatment were correlated with TNM stage,Gleason score,endocrine therapy duration and distant metastasis status(all P<0.05).The survival analysis showed that the median PFS in high CgA level group and high NSE level group were significantly lower than those in low CgA level group (χ~2=6.233 and 8.669,all P<0.05)and low NSE level group(χ~2=5.763 and 7.388,all P<0.05).Cox regression analysis showed that distant metastasis,high CgA and NSE levels were independent risk factors for PFS,and high CgA and high NSE levels were independent risk factors for OS(all P <0.05).Conclusion Serum CgA and NSE levels are influencing factors of the survival time of CRPC patients treated by abiraterone;the high level is associated with high risk of poor prognosis,which could be used as effective indexes for prognosis evaluation.