经多西他赛化疗失败的mCRPC患者应用醋酸阿比特龙联合泼尼松龙治疗的疗效及预后因素分析

Analysis of curative effect and prognostic factors of combination therapy of abiraterone acetate and prednisolone in patients with mCRPC who failed to receive docetaxel chemotherapy

目的:研究经多西他赛化疗失败的转移性去势抵抗前列腺癌(metastatic castration-resistant prostate cancer,mCRPC)患者应用醋酸阿比特龙联合泼尼松龙治疗的疗效,以及分析影响预后的危险因素。方法:回顾性分析2017年2月—2018年2月邢台医学高等专科学校第二附属医院收治的145例mCRPC患者,经多西他赛化疗失败后均采用醋酸阿比特龙联合泼尼松龙治疗。收集患者的临床资料,研究联合治疗的效果以及预后情况,采用Cox单因素和多因素分析影响预后的危险因素。结果:145例患者中位随访时间为21.8(15.2,23.8)个月,mCRPC患者接受醋酸阿比特龙联合泼尼松龙治疗的中位前列腺特异性抗原无进展生存期(PSA PFS)为9.2(8.4,10.3)个月,中位总生存期(OS)为23.6(21.5,25.4)个月。患者主要不良反应为水钠潴留(28.97%)、低血钾(19.31%)、高血压(9.66%),总体耐受性良好,多为1~2度。Cox单因素、多因素分析结果显示,ECOG评分(0~1分vs.2分)、骨转移灶数(≤10个vs.>10个)、肝转移是影响mCRPC患者接受醋酸阿比特龙联合泼尼松龙治疗预后(OS、PSA PFS)的独立危险因素(P<0.05)。结论:经多西他赛化疗失败的mCRPC患者应用醋酸阿比特龙联合泼尼松龙治疗具有良好的治疗效果,ECOG评分、骨转移灶数、肝转移与联合治疗mCRPC患者的OS、PSA PFS显著相关。

Objective:To study the efficacy of abiraterone acetate combined with prednisolone in patients with metastatic castration-resistant prostate cancer(mCRPC)who failed in docetaxel chemotherapy,and to analyze the prognostic risk factors.Methods:From February 2017to February 2018,145patients with mCRPC in our hospital were retrospectively analyzed.After failing in docetaxel chemotherapy,all patients were treated with abiraterone acetate combined with prednisolone.The data of patients'medical records were collected to study the effect and prognosis of combined treatment.The risk factors influencing the prognosis were analyzed by univariate and multivariate Cox analysis.Results:The median follow-up time of 145patients was 21.8(15.2,23.8)months.The median PSA PFS and OS of mCRPC patients treated with abiraterone acetate combined with prednisolone were 9.2(8.4,10.3)months and 23.6(21.5,25.4)months,respectively.The main adverse reactions of the patients were water and sodium retention(28.97%),hypokalemia(19.31%),and hypertension(9.66%).The overall tolerability was much better,mostly from 1to 2degrees.Univariate and multivariate Cox analysis showed that ECOG score(0-1vs.2),the number of bone metastases(≤10vs.>10),and liver metastasis were independent risk factors affecting the prognosis(OS,PSA PFS)of mCRPC patients treated with abiraterone acetate combined with prednisolone(P<0.05).Conclusion:The treatment of mCRPC patients treated with abiraterone acetate combined with prednisolone who failed in docetaxel chemotherapy has a good therapeutic effect.ECOG score,number of bone metastases,and liver metastasis are significantly related to OS and PSA PFS in mCRPC patients treated with the combination therapy.