全雄激素阻断治疗后进展到去势抵抗性前列腺癌时间预测因素分析

发布时间：2018-04-14 19:35

  本文选题：前列腺癌 + 全雄激素阻断　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:前列腺癌是威胁男性生命健康最常见的恶性肿瘤之一。全雄激素阻断治疗(MAB)是晚期前列腺癌的首选治疗方案,但全雄激素阻断治疗后,患者进展到去势抵抗性前列腺癌时间(TTCRPC)具有较大差异,提示并非所有的晚期前列腺癌患者都能够从传统全雄阻断治疗中获益,本文研究拟回顾性分析我院行全雄阻断治疗前列腺癌患者的临床资料,寻找精准快速可预测进展到去势抵抗性前列腺癌时间的临床指标用于早期筛选出内分泌治疗不敏感的患者,从而尽早的制定新的个体化治疗方案,改善患者预后。方法:回顾性分析大连医科大学附属第二医院2006年1月至2015年12月经前列腺穿刺确诊前列腺癌并行MAB治疗患者121例。根据标准排除伴有其他系统肿瘤患者,MAB治疗前进行经尿道前列腺电切术患者,行手术去势及临床数据不全患者。最终有89例患者入选,所有患者随访时间均大于1年,其中有66例患者发生CRPC。依据患者进展为CRPC时间及随访时间将89例患者分为A组(CRPC进展时间≤1年)26例及B组(CRPC进展时间1年)63例。收集比较两组患者的年龄、BMI、T分期、Gleason评分、骨ECT结果、治疗前PSA、前列腺体积以及治疗后PSA变化等相关指标,采用Log rank检验分析TTCRPC的预测因素。结果:统计89例全雄激素阻断治疗患者的临床资料,其中入院基本资料为平均年龄:73.1±9.7岁,平均BMI:24.0±0.3kg/m2,平均前列腺体积:51.2±34.0ml,中位gleason评分(范围):8(4~10)分,中位T分期(范围):T3(2~4)期中位骨转移数量(范围):4(0~16)个,其中肺转移8例。所有患者均规律接受全雄激素阻断治疗,我们对患者随访的时间为1~48月不等,平均时间20.6±13.0月。随访期间发生CRPC的患者一共66例,其中,1年内发生CRPC的患者26例(39.4%),12~24个月发生CRPC患者12例(18.2%),24个月以上发生CRPC的患者28例(42.4%)。全雄激素阻断治疗后临床资料为:平均PSA最低值:4.4±13.2ng/ml,平均PSA最低值时间:7.4±3.5月,其中患者的PSA最低时间多分布于4~12月间,PSA最低值时间≥6月的患者49例(55.6%)。通过t检验和卡方检验分析并比较A、B两组患者的临床资料,A组患者骨转移灶数量≤5个7例(29.2%),5个19例(73.1%);平均PSA最低值:14.7±21.4ng/ml,平均PSA最低值时间:4.9±2.0月;B组患者骨转移灶数量≤5个36例(57.1%),5个27例(42.9%);平均PSA最低值:0.2±0.6ng/ml,平均PSA最低值时间:8.4±3.6月;我们发现治疗前骨转移数量(P=0.09)、PSA最低值(P=0.002)以及PSA最低值发生时间(P0.001),在两组数据中具有统计学差异。Log rank检验用于比较不同亚组CRPC进展时间预后的差异,结果显示Gleason评分(≤6 vs.7 vs.≥8分)(P=0.01),T分期(2 vs.3 vs.≥4期)(0.033)骨转移数量(≤5 vs.5个)(P=0.02),PSA最低值(≤0.2 ng/ml vs.0.2 ng/ml)(P0.001),PSA最低值发生时间(≤6月vs.6月)(P0.001)两亚组中CRPC进展时间具有统计学差异。结论:1.临床上,使用全雄阻断治疗的晚期转移性前列腺患者发生CRPC时间具有明显差异;2.Gleason≥7评分、骨转移数量5个、T4期、PSA最低值0.2 ng/ml及PSA最低值发生时间≤6月的患者进展为去势抵抗前列腺癌时间更短;3.其中,PSA最低值及发生时间虽与CRPC进展时间具有显著相关性,但对于大部分患者而言,在获得PSA最低值及最低值时间时,患者已经治疗了较长时间,失去了作为临床指标的早期预测作用;
[Abstract]:Objective: prostate cancer is one of the most common malignant tumor of the male health threat. The treatment of total androgen blockade (MAB) is the preferred treatment for advanced prostate cancer, but androgen deprivation therapy, patients progress to castration resistant prostate cancer (TTCRPC) with time are different, suggesting that not all prostate cancer patients from the traditional all male blocking treatment benefit, quasi retrospective analysis of clinical data for complete androgen deprivation therapy for patients with prostate cancer in our hospital for this study, looking for accurate prediction can progress to clinical indicators of castration resistant prostate cancer for early screening time is not sensitive to endocrine therapy in patients with individualized treatment and new as soon as possible, improve the prognosis of patients. Methods: a retrospective analysis of the Second Affiliated Hospital of Dalian Medical University from January 2006 to 2015 12 menstrual prostate biopsy. Diagnosis of prostate cancer in 121 cases of MAB patients treated with parallel. According to the exclusion criteria with other cancer patients, MAB treatment before transurethral resection of prostate, surgical castration and clinical data in all. Finally 89 patients were enrolled. All patients were followed up for more than 1 years, of which 66 cases of patients with progression according to CRPC CRPC. with time and follow-up of 89 patients were divided into A group (CRPC < 1 years in 26 cases) and B group (CRPC in 1 years) collected in 63 cases. The two groups were comparable in age, BMI, T stage, Gleason score, bone ECT results before treatment, PSA. After the treatment of prostate volume and change of PSA and other related indicators, analyzed by Log rank test predictive factors of TTCRPC. Results: 89 cases of androgen deprivation therapy in patients with clinical data, the admission of the basic data for the average age: 73.1 + 9.7 years, an average of BMI:24.0 + 0.3kg/m2, 骞冲潎鍓嶅垪鑵轰綋绉，

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