高肿瘤负荷转移性激素敏感前列腺癌患者预后因素分析

Prognostic factors in patients with high-volume disease metastatic hormone-sensitive prostate cancer

目的探讨影响高肿瘤负荷转移性激素敏感前列腺癌(HVD-mHSPC)患者预后的预测因素。方法分析2015年6月至2018年12月郑州大学附属肿瘤医院泌尿外科收治的97例HVD-mHSPC患者的临床资料。受试者工作特征(ROC)曲线确定中性粒细胞与淋巴细胞比值(NLR)、预后营养指数(PNI)、前列腺特异性抗原(PSA)、血红蛋白(Hb)及碱性磷酸酶(ALP)的最佳临界值,分别为3.0、48.3、507.0、12.3、94.0。单因素及多因素分析患者无进展生存期(PFS)和总生存期(OS)的预后影响因素。单因素分析采用Kaplan-Meier生存分析,多因素分析采用Cox回归。结果患者中位PFS为13个月,中位OS为49个月。单因素分析显示,年龄>70岁、PSA>507 ng/ml、Hb>12.3 g/dl、PNI>48.3、肿瘤分期>T2、PSA低值<0.2 ng/ml及联用化疗是HVD-mHSPC患者FPS的预测因素(χ^(2)=5.334、5.665、10.289、10.522、5.002、57.789、20.217,P<0.05)。Hb>12.3 g/dl、PNI>48.3、PSA低值<0.2 ng/ml及联用化疗是患者OS的预测因素(χ^(2)=7.562、8.436、24.698、7.218,P<0.01)。多因素Cox回归分析显示,肿瘤分期>T2风险比(HR)=1.76,95%置信区间(CI):1.00~3.10,P<0.05、PSA低值<0.2 ng/ml(HR=0.22,95%CI:0.12~0.40,P<0.01)及联用化疗(HR=0.41,95%CI:0.24~0.70,P<0.01)是患者PFS的独立预测因素。PSA低值<0.2 ng/ml是患者OS的独立预测因素(HR=0.26,95%CI:0.12~0.60,P<0.01)。结论肿瘤分期、是否联用化疗及PSA低值可以预测HVD-mHSPC患者的预后,有助于指导临床治疗。

Objective To explore the prognostic factors in patients with high-volume disease metastatic hormone-sensitive prostate cancer(HVD-mHSPC).Methods The clinical data of 97 patients with HVD-mHSPC from Jun.2015 to Dec.2018 in Affiliated Cancer Hospital of Zhengzhou University were analyzed.The optimal cut-off value for neutrophil-lymphocyte ratio(NLR),prognostic nutrition index(PNI),prostate specific antigen(PSA),hemoglobin(Hb)and alkaline phosphatase(ALP),which was determined using ROC curve analysis for overall survival(OS),was 3.0,48.3,507.0,12.3,94.0 respectively.The prognostic factors for progression-free survival(PFS)and OS were analyzed by univariate and multivariate analysis.Kaplan-meier analysis was used for univariate analysis and the Cox regression analysis was used for multivariate analysis.Results The median PFS was 13 months and median OS was 49 months.Univariate analysis showed that age>70 years,PSA>507 ng/ml,Hb>12.3 g/dL,PNI>48.3,tumor stage>T2,PSA nadir<0.2 ng/ml and combined chemotherapy were predictive factors for FPS in HVD-mHSPC patients(χ^(2)=5.334,5.665,10.289,10.522,5.002,57.789,20.217,P<0.05),and Hb>12.3 g/dL,PNI>48.3,PSA nadir<0.2 ng/ml and combined chemotherapy were predictive factors for OS(χ^(2)=7.562,8.436,24.698,7.218,P<0.01).Multivariate Cox regression analysis showed that tumor stage>T2[hazard ratio(HR)=1.76,95%confidence interval(CI):1.00-3.10,P<0.05],PSA nadir<0.2 ng/ml(HR=0.22,95%CI:0.12-0.40,P<0.01)and combined chemotherapy(HR=0.41,95%CI:0.24-0.70,P<0.01)were independent predictive factors for PFS,and PSA nadir<0.2 ng/ml was independent predictive factors for OS(HR=0.26,95%CI:0.12-0.60,P<0.01).Conclusion Tumor stage and combined chemotherapy and PSA nadir can predict the prognosis of HVD-mHSPC patients and guide clinical treatment.