去势抵抗性前列腺癌发生的预测因素分析

Analysis of prognostic factors for castration-resistant prostate cancer progression

目的:筛选预测去势抵抗性前列腺癌发生的危险因素,评估危险度分组对患者预后预测的可行性。方法:于2005~2019年间在我院经前列腺穿刺活检确诊的前列腺癌患者中筛选病例。搜集确诊时前列腺特异性抗原(PSA)值、治疗过程中PSA的最低值、达到PSA最低值的时间及危险度分组等临床资料。利用Cox比例风险模型对影响去势抵抗性前列腺癌发生的独立因素进行筛选。结果:PSA最低值(HR:2.192,95%CI:1.326~3.623,P=0.002)、达到最低值的时间(HR:0.558,95%CI:0.343~0.907,P=0.019)、骨转移情况(HR:2.602,95%CI:1.546~4.381,P=0.000)及危险度分组与去势抵抗性前列腺癌的发生密切相关。依据上述指标构建新的风险分组系统,将患者分为低风险组、中等风险组和高风险组。Cox回归分析表明,中等风险组(HR:2.555,95%CI:1.353~4.822,P=0.004)和高风险组(HR:8.79,95%CI:4.403~17.549,P=0.004)均为去势抵抗性前列腺癌发生的危险因素。结论:PSA最低值、达到最低值的时间、骨转移是内分泌治疗患者发生去势抵抗性前列腺癌的预测因素,基于Gleason评分的最新危险度分组可以用于预测患者的预后。依据上述指标建立的新的风险分组系统可以用于筛选高危患者。

Objective:To screen the prognostic factors for castration-resistant prostate cancer(CRPC)and to evaluate the feasibility of risk groups for prognosis in prostate cancer patients.Methods:Patients with prostate cancer confirmed by biopsy in our hospital between 2005 and 2019 were enrolled according to predefined criteria.Patient age,prostatespecific antigen(PSA)values at diagnosis,PSA nadir value,time to PSA nadir(TTN),risk groups,and other variables were collected.The Cox proportional hazard regression model was used to identify the independent risk factors for CRPC.Results:PSA nadir≥0.15μg/L,TTN<6 months,bone metastasis,unfavorable intermediate-risk group,and highrisk group were independent risk factors for CRPC progression.A new hazard groups system was built according to abovementioned factors.Cox regression analysis indicated that the intermediate hazard group and high hazard group were risk factors for CRPC.Conclusion:PSA nadir,TTN,bone metastasis,and risk groups are prognostic factors for CRPC,unfavorable intermediate-risk group and high-risk group are associated with poor prognosis.A new hazard groups system built on these prognostic factors could be used to screen patients with poor prognosis.