阿比特龙治疗转移性去势抵抗性前列腺癌的PSA闪烁现象观察

Observation of PSAflare in the treatment of metastatic castration resistant prostate cancer with abiraterone

目的探究醋酸阿比特龙联合泼尼松治疗转移性去势抵抗性前列腺癌(mCRPC)PSA闪烁(PSAflare)现象的临床特点。方法回顾性分析98例mCRPC应用醋酸阿比特龙联合泼尼松治疗患者的临床资料,分析PSAflare现象的临床特征及其与预后的关系。结果总PSA反应率66.2%,中位PSA无进展生存期(psaPFS)、放射学无进展生存期(rPFS)及总生存期(OS)分别为7.03、7.93及16.90个月,不良反应可耐受,PSAflare现象发生率12.2%(12/98),中位PSA升高幅度70.95%(39.74%~188.65%),中位持续时间35 d(27~113 d),骨转移点数>10的患者出现PSAflare风险增加(OR=4.957,95%CI:1.359~18.082)。按是否发生PSAflare现象分组后显示两组的psaPFS、rPFS及OS均无显著差异(P>0.05),生存分析显示两组OS差异无统计学意义(χ^2=0.051,P=0.822),提示PSAflare现象不影响预后。结论mCRPC患者应用阿比特龙整体疗效及安全性可接受,出现PSAflare现象的概率不高,且不影响患者预后,持续应用3个月或可更好鉴别PSAflare现象与疾病进展,不宜过早中断或更改治疗,此应得到临床重视。

Objective To investigate the clinical characteristics of PSAflare in the treatment of mCRPC with abiraterone.Methods Ninety-eight patients with mCRPC treated with abirbitron acetate and prednisone were analyzed retrospectively.Results The overall PSA response rate of abiraterone was 66.2%,the median psaPFS,rPFS and OS were 7.03,7.93 and 16.90 months,respectively,and the side effects were tolerable.The incidence of PSAflare was 12.2%(12/98),the higher amplitude of PSA was 70.95%(39.74%-188.65%),and the duration was 35 days(27 days-113 days).Patients with bone metastasis points>10 had an increased risk of PSAflare(OR=4.957,95%CI:1.359-18.082).There was no statistical difference in psaPFS,rPFS or OS between the two groups(P>0.05).There was no statistical significance in Kaplan-meier survival analysis(χ^2=0.051,P=0.822).Conclusions The efficacy and safety of abiraterone in mCRPC patients are acceptable.The probability of PSAflare is low and does not affect the prognosis of patients.Continue to use for 3 months may better distinguish between PSAflare and disease progression.