间歇性内分泌治疗对中晚期前列腺癌患者的疗效研究

发布时间：2018-04-05 14:03

本文选题：前列腺癌　切入点：内分泌治疗　出处：《大连医科大学》2014年硕士论文

【摘要】：目的：评估间歇性内分泌治疗对中晚期前列腺癌症患者的疗效，比较间歇性内分泌治疗与持续性内分泌治疗两种治疗方法的疗效差异。方法：纳入2006年1月1日—2010年1月1日大连医科大学附属第一医院泌尿外科诊断为中晚期前列腺癌，在本院接受分泌治疗且有完整随访资料的患者。患者均行手术或药物去势+比卡鲁胺治疗，按照间歇性内分泌治疗或持续性内分泌治疗将患者分为间歇组与持续组。间歇组治疗方法为间歇性皮下注射戈舍瑞林及口服抗雄激素药物比卡鲁胺；持续组治疗方法为行睾丸切除术或持续性皮下注射戈舍瑞林及口服抗雄激素药物比卡鲁胺。所有患者均规律随访，定期检测PSA水平及其他检查，收集随访资料。采用SPSS19.0统计学软件对患者的基线资料、PSA、临床特征、总生存率、副反应发生率、治疗费用、进展为雄激素非依赖性前列腺癌的时间进行分析。结果： 1.共收集符合纳入标准并有完整资料患者183例，均通过病理证实前列腺癌，均为局部晚期前列腺癌（T3/T4/NX-1M0）或转移性前列腺癌（任何T任何N Ml）。排除失访患者24例，只做手术没有口服比卡鲁胺患者24例，只皮下注射戈舍瑞林没有口服比卡鲁胺患者12例。最终持续组共106例患者，其中32例患者（30.2%）接受手术去势，74例患者（69.8%）接受药物去势。间歇组共17例患者，均行药物去势。 2.间歇组与持续组患者的PSA水平比较，治疗后3个月差异无统计学意义（P=0.121），治疗后6个月比较差异亦无统计学意义（P=0.948）。 3.间歇组与持续组患者的临床症状比较，治疗后3个月、治疗后6个月排尿梗阻发生率、骨痛发生率、骨转移灶阳性率差异均无统计学意义（P＞0.05）。 4.间歇组与持续组患者的生存率比较，两组患者总生存率差异无统计学意义（P=0.256）。 5．间歇组与持续组患者进展为雄激素非依赖性前列腺癌的时间比较，两组差异有统计学意义（P=0.044）。 6．间歇组与持续组患者治疗期间副反应发生率比较，除外胃肠道反应发生率差异无统计学意义（P=0.081），，间歇组热潮红症状、性欲和勃起功能丧失、骨质疏松、乳房胀痛发生率与持续组相比差异均有统计学意义（P=0.024、0.030、0.003、0.032）。 7.间歇组与持续组患者治疗费用比较，间歇组患者平均治疗费用为（29946±4526）元，持续组患者平均治疗费用为（84177±5247）元，两组患者差异有统计学意义（P=0.000）。结论:间歇性内分泌治疗是前列腺癌治疗的有效手段，可显著的延缓患者进展为雄激素非依赖性前列腺癌的时间，改善尿路梗阻、骨痛骨转移等症状，延长生存期，降低治疗期间副反应发生率，降低治疗费用，提高患者生活质量。
[Abstract]:Objective: to evaluate the efficacy of intermittent endocrine therapy in patients with advanced prostate cancer and to compare the efficacy between intermittent endocrine therapy and persistent endocrine therapy.Methods: from January 1, 2006 to January 1, 2010, the patients diagnosed as advanced prostate cancer in urology department of the first affiliated Hospital of Dalian Medical University were treated with secretory therapy in our hospital and had complete follow-up data.The patients were divided into intermittent group and continuous group according to intermittent endocrine therapy or continuous endocrine therapy.The intermittent group was treated by intermittent subcutaneous injection of goserelin and oral androgen drug Bicalamine, while the continuous group was treated by orchiectomy or continuous subcutaneous injection of goserelin and oral androgen drug bizu_person1# amine.All patients were followed up regularly, PSA level and other examinations were measured regularly, and follow-up data were collected.The baseline data, clinical features, overall survival rate, incidences of side effects, cost of treatment and time of progression to androgen independent prostate cancer were analyzed by SPSS19.0 software.Results:1.A total of 183 patients who met the inclusion criteria and had complete data were collected. All of them were confirmed by pathology, all of which were locally advanced prostate cancer (T3 / T4 / NX-1M0) or metastatic prostate cancer (any T, any NMlP).24 cases were excluded, 24 cases were not treated by operation, and 12 cases were treated by subcutaneous injection of goserelin.In the final continuous group, 106 patients, including 32 patients with 30. 2% of the total, 74 patients with castration and 74 patients with castration received drug castration.In the intermittent group, 17 patients were castrated.2.There was no significant difference in PSA level between intermittent group and continuous group 3 months after treatment, and there was no significant difference at 6 months after treatment.3.There was no significant difference in the incidence of urination obstruction, bone pain and positive rate of bone metastasis between intermittent group and continuous group (P > 0.05) 3 months after treatment and 6 months after treatment.4.There was no significant difference in the overall survival rate between the intermittent group and the continuous group.5.The time of progression to androgen independent prostate cancer was significantly different between intermittent group and continuous group (P 0.044).6.The incidences of side effects in intermittent group and continuous group were not significantly different between intermittent group and continuous group. There was no significant difference in incidence rate of gastrointestinal reaction between intermittent group and continuous group, but there was no significant difference in incidence rate of gastrointestinal reaction between intermittent group and continuous group. In intermittent group, symptoms of hot fever, loss of sexual desire and erectile function, osteoporosis,The incidence of breast distending pain was significantly different from that of the continuous group.7.The average treatment cost of intermittent group and continuous group was 29946 卤4526 yuan and 84177 卤5247 yuan, respectively. The difference between the two groups was statistically significant.Conclusion: intermittent endocrine therapy is an effective method for the treatment of prostate cancer. It can significantly delay the progression of androgen independent prostate cancer, improve the symptoms of urinary tract obstruction, bone pain and bone metastasis, and prolong the survival time.Reduce the incidence of side effects during treatment, reduce the cost of treatment, improve the quality of life of patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25

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