NHT后血清IL-6对前列腺癌RP病人预后影响

THE VALUE OF SERUM IL-6 LEVEL AFTER NEOADJUVANT HORMONAL THERAPY IN PREDICTING THE PROGNOSIS OF PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY

目的探讨新辅助内分泌治疗(NHT)后血清白细胞介素-6(IL-6)水平在预测前列腺癌根治性前列腺切除术(RP)后生化复发中的价值。方法收集接受NHT后行RP的294例前列腺癌病人的临床及病理资料,所有病人术前均使用酶联免疫吸附法检测血清IL-6浓度,按其中位数值分为高水平组和低水平组,比较两组间临床病理特征的差别,应用Kaplan-Meier生存分析方法、Cox比例风险模型分析NHT后IL-6水平对病人预后的影响。结果高水平组和低水平组间年龄、体质量指数、吸烟、高血压、糖尿病、切缘阳性、精囊侵犯及穿刺Gleason评分差异无统计学意义(P>0.05);与IL-6低水平组相比,高水平组包膜侵犯率、淋巴结阳性率、T分期、前列腺特异性抗原(PSA)水平均显著升高(χ^(2)=3.890~13.397,P<0.01)。Kaplan-Meier生存分析显示,IL-6高水平组病人生化复发的概率明显高于低水平组(χ^(2)=6.404,P<0.05)。多因素Cox比例风险回归模型分析显示,血IL-6水平(HR=1.531,95%CI=1.011~2.318,P<0.05)、淋巴结转移(HR=1.818,95%CI=1.093~3.025,P<0.05)、T分期(HR=1.769,95%CI=1.132~2.762,P<0.05)、PSA≥20μg/L(HR=3.108,95%CI=1.421~6.799,P<0.05)是影响术后生化复发的独立危险因素。结论接受NHT后前列腺癌病人血清IL-6水平可协助预测RP术后生化复发,有助于临床决策的选择。

Objective To study the value of serum interleukin-6(IL-6)level after neoadjuvant hormonal therapy(NHT)in predicting biochemical recurrence after radical prostatectomy(RP).Methods The clinicopathological data of 294 patients with prostate cancer who underwent RP after NHT were collected.Enzyme-linked immunosorbent assay was used to measure the preoperative serum IL-6 concentration of the patients.According to the median concentration of IL-6,the patients were divided into high-level group and low-level group for comparison of clinicopathological characteristics.The impact of post-NHT IL-6 level on prognosis was analyzed using Kaplan-Meier survival analysis and Cox proportional risk model.Results There were no significant differences between the two groups in terms of age,body mass index,smoking,hypertension,diabetes,positive margin,seminal vesicle invasion,and Gleason scores(P>0.05).Compared with the low-level group,the high-level group showed significantly increased capsule invasion rate,positive rate of lymph node,T staging,and prostate specific antigen level(χ^(2)=3.890-13.397,P<0.01).According to the Kaplan-Meier survival analysis,the probability of biochemical recurrence was significantly higher in the high-level group than in the low-level group(χ^(2)=6.404,P<0.05).A multivariate Cox proportional risk regression model was used to identify the independent risk factors for postoperative biochemical recurrence,including IL-6 level(HR=1.531,95%CI=1.011-2.318,P<0.05),lymph node metastasis(HR=1.818,95%CI=1.093-3.025,P<0.05),T staging(HR=1.769,95%CI=1.132-2.762,P<0.05),and PSA≥20μg/L(HR=3.108,95%CI=1.421-6.799,P<0.05).Conclusion Serum IL-6 level after NHT can be useful in predicting biochemical recurrence after RP and making informed clinical decisions.