转移性去势敏感前列腺癌患者疼痛相关因素及其与预后的关系

Pain related factors and their relationship with prognosis in patients with metastatic castration-sensitive prostate cancer

目的探讨转移性去势敏感前列腺癌(mCSPC)患者疼痛相关因素及其与预后的关系。方法回顾性选取2014年1月至2020年1月萍乡市人民医院收治的365例mCSPC患者作为研究对象,将其中有癌因性疼痛症状的127例患者纳入疼痛组,将另外238例无疼痛症状的患者纳入无痛组。比较两组患者的一般资料与临床指标以明确疼痛的相关因素,并代入进一步logistic分析以明确各相关因素与疼痛症的关系。随访两组患者无病情进展生存时间(PFS)、总生存时间(OS),以随访结束或患者预后死亡为终点,使用Cox回归分析疼痛症状与患者预后结局的关系。结果单因素分析结果显示,Gleason分级评分、血清PSA水平、ALP水平、淋巴结受累、骨转移、骨转移数目是mCSPC患者疼痛发生的相关因素(P<0.05);两组患者年龄、病程、BMI、病灶直径、有内脏转移比较,差异无统计学意义(P>0.05)。多因素分析结果显示,Gleason分级评分、血清PSA水平、ALP水平、淋巴结受累、骨转移、骨转移数目为mCSPC患者疼痛发生的危险因素(P<0.05)。疼痛组PFS、OS短于无痛组,差异有统计学意义(P<0.05)。mCSPC患者发生疼痛症状为病情进展、总生存时间缩短的独立危险因素(P<0.05)。结论骨转移与内脏转移的发生、组织学分级Gleason评分较高,肿瘤标志物水平较高多提示转移性去势敏感前列腺癌患者发生疼痛症状,为患者不良预后的独立危险因素。

Objective To explore the relationship between pain related factors and prognosis in patients with metastatic castration-sensitive prostate cancer(mCSPC).Methods A total of 365 patients with mCSPC admitted to Pingxiang People′s Hospital from January 2014 to January 2020 were retrospectively selected as the research objects.Among these of 127 patients with cancer-related pain symptoms were included in the pain group,and another 238 patients without pain symptoms were included in the pain-free group.The general data and clinical indicators of patients in the two groups were compared to determine the pain related factors,and further logistic analysis was performed to determine the relationship between the related factors and pain.Progression-free survival(PFS)and overall survival(OS)of patients in the two groups were followed up,and the end of follow-up or patient prognosis and death were taken as the endpoint.Cox regression was used to analyze the relationship between pain symptoms and patient outcomes.Results The univariate analysis showed that Gleason grade score,serum PSA level,ALP level,lymph node involvement,bone metastasis and bone metastasis were related to the occurrence of pain in mCSPC(P<0.05).The age,course,BMI,lesion diameter,and visceral metastasis between the two groups were not significant(P>0.05).The results of the multivariate analysis showed that the Gleason grade score,serum PSA level,ALP level,lymph node involvement,bone metastasis,and the number of bone metastases were the risk factors for pain occurrence in mCSPC patients(P<0.05).PFS and OS were shorter than painless groups in the pain groups,which were statistically significant(P<0.05).Pain symptoms in mCSPC patients are an independent risk factor for disease progression and shortened overall survival time(P<0.05).Conclusion The occurrence of bone metastasis and visceral metastasis,high histological grade Gleason score,and high level of tumor markers mostly suggest pain symptoms in patients with metastatic castration-sensitive prostate cancer,which is an independent risk factor for poor prognosis.