89锶（89Sr）与唑来膦酸对前列腺癌骨转移疗效的评估

发布时间：2018-06-15 00:00

本文选题：前列腺癌骨转移 + ~(89)锶　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:探讨~(89)Sr与唑来膦酸对前列腺癌骨转移治疗效果。方法:回顾性分析自南昌大学第一附属医院2014年01月至2016年6月88例晚期前列腺癌的患者。入院后均完善直肠指诊(DRE)、PSA检测、经直肠彩超检查(TRUS),并经直肠前列腺穿刺活检确诊为前列腺癌,骨扫描有单个或多个部位骨转移。88例分成3组(甲组28例,乙组30例,丙组30例):相关资料包括患者年龄(甲组64.24±7.32,乙组63.82±8.43,丙组63.12±7.43);Gleason评分(≤6分:4/28,5/30,5/30;7分:2/28,3/30,2/30;≥8分:22/28,22/30,23/30);血清TPSA(10ng/ml:1/28,1/30,0/30;10~20ng/ml:4/28,5/30,5/30;20ng/ml:23/28,24/30,25/30)。治疗:甲组均以~(89)Sr148 MBq/次(4 mci)静脉注射,3月一疗程;乙组均以4 mg唑来膦酸+0.9%100 ml生理盐水静脉滴注,每月1次,3月一疗程;88例患者均需采用内分泌阻断雄激素治疗。根据门诊随访评估患者骨转移病灶数量、骨痛疗效、治疗后疼痛指数、血常规及肝功能变化、不良反应。计量资料不同组间比较采用样本t检验,计数资料采用X2检验,P0.05为差异有统计学意义。结果:(1)骨转移病灶数量治疗有效率:甲组(85.7%)较乙组(60%)高,有统计学意义(P=0.0290.05);甲组(85.7%)较丙组(50%)高,有统计学意义(P=0.0040.05);乙组(60%)较丙组(50%)高,无统计学意义(P=0.4360.05)。(2)骨痛疗效缓解率:甲组(92.9%)较乙组(70%)偏高,有统计学意义(P=0.0260.05);甲组(92.9%)较丙组(66.7%)高,有统计学意义(P=0.0140.05);乙组70%)较丙组(66.7%)高,无统计学意义(P=0.7810.05)。(3)治疗后疼痛指数:无反应率:甲组(3.6%)较乙组(6.7%)低,无统计学意义(P=0.5950.05);甲组(3.6%)较丙组(13.3%)低,无统计学意义(P=0.1860.05);乙组(6.7%)较丙组(13.3%)低,无统计学意义(P=0.3890.05)。中等反应率:甲组(17.9%)较乙组(26.7%)低,无统计学意义(P=0.4210.05);甲组(17.9%)较丙组(53.3%)低,有统计学意义(P=0.0050.05);乙组(26.7%)较丙组(53.3%)低,有统计学意义(P=0.0350.05)。反应良好率:甲组(32.1%)较乙组(46.7%)低,无统计学意义(P=0.2940.05);甲组(32.1%)较丙组(26.7%)高,无统计学意义(P=0.6470.05);乙组(46.7%)较丙组(26.7%)高,无统计学意义(P=0.1080.05)。反应非常好率:甲组(46.4%)较乙组(20%)高,有统计学意义(P=0.0320.05);甲组(46.4%)较丙组(6.7%)高,有统计学意义(P=0.0010.05);乙组(20%)较丙组(6.7%)高,无统计学意义(P=0.1290.05)。(4)肝功能治疗前后无明显变化,~(89)Sr常见的不良反应是骨髓抑制(50%),以轻度骨髓抑制为主。唑来膦酸常见副作用是消化系统症状(13.3%)。血液系统不良事件:1级:甲组(28.6%)较乙组(6.7%)高,有统计学意义(P=0.0270.05);甲组(46.4%)较丙组(3.3%)高,有统计学意义(P=0.0080.05);乙组(6.7%)较丙组(3.3%)高,无统计学意义(P=0.5540.05)。2级:甲组(14.3%)较乙组(3.3%)高,无统计学意义(P=0.1380.05);甲组(46.4%)较丙组(0%)高,有统计学意义(P=0.0320.05);乙组(3.3%)较丙组(0%)高,无统计学意义(P=0.3130.05)。3级:甲组(7.14%)较乙组(0%)高,无统计学意义(P=0.1360.05);甲组(7.14%)较丙组(0%)高,无统计学意义(P=0.1360.05);乙组(0%)与丙组(0%)无法比较。结论:(1)前列腺癌骨转移病灶数量减少:~(89)Sr联合内分泌疗效明显优于唑来膦酸联合内分泌、单独内分泌疗效。(2)骨痛疗效缓解率:~(89)Sr联合内分泌疗效明显优于唑来膦酸联合内分泌、单独内分泌疗效。(3)治疗后疼痛指数:反应非常好率,~(89)Sr联合内分泌疗效明显优于唑来膦酸联合内分泌、单独内分泌疗效;无反应率、中等反应率、反应良好率无统计学差异。(4)血液系统不良事件1级:~(89)Sr较唑来膦酸多见;~(89)Sr不良反应比唑来膦酸少见。肝功能治疗前后无明显变化。
[Abstract]:Objective: To investigate the effect of ~ (89) Sr and zoledronic acid on bone metastasis of prostate cancer. Methods: retrospective analysis of 88 patients with advanced prostate cancer from 01 months to June 2016 2014 from the First Affiliated Hospital of Nanchang University. After admission, the rectal finger diagnosis (DRE), PSA test, direct Chang Caichao examination (TRUS), and transrectal prostate biopsy were confirmed. For prostate cancer, bone scan was divided into 3 groups of.88 cases (28 cases in group A, 30 in group B, 30 in group C). The related data included patients' age (64.24 + 7.32, 63.82 + 8.43 and 63.12 + 7.43 in C); Gleason score (< < < < 4/28,5/ > > > 2/28,3/30,2/30; < < < < 64.24 > > 22/28,22/30,23/30); and serum TPSA (10ng/m). L:1/28,1/30,0/30; 10~20ng/ml:4/28,5/30,5/30; 20ng/ml:23/28,24/30,25/30). Group A was treated with ~ (89) Sr148 MBq/ (4 MCI) intravenous injection, a course of treatment in March; group B with 4 mg zoledronic acid +0.9%100 ml normal saline intravenous drip, 1 times a month, and a course of treatment; 88 patients all need endocrine blocking androgens. The number of bone metastases, the effect of bone pain, the pain index after treatment, the change of blood routine and liver function, the adverse reaction. The t test was used in different groups. The count data were tested by X2 test, and the difference of P0.05 was statistically significant. (1) the effective rate of the number of bone metastases was: (85.7%) compared with group B (60%) High, statistically significant (P=0.0290.05); group A (85.7%) was higher than group C (50%) and was statistically significant (P=0.0040.05); group B (60%) was higher than group C (50%) and had no statistical significance (P=0.4360.05). (2) the remission rate of bone pain: (92.9%) was higher than group B (70%), statistically significant (P=0.0260.05); group A (92.9%) was higher than group C (66.7%) and statistically significant P=0.0140.05, group B 70%) was higher than group C (66.7%), no statistical significance (P=0.7810.05). (3) the pain index after treatment: no response rate: group A (3.6%) was lower than group B (6.7%), no statistical significance (P=0.5950.05); group A (3.6%) was lower than group C (13.3%), no statistical significance (P=0.1860.05); group B (6.7%) was lower than group C (13.3%), and was not statistically significant (P=0. 3890.05) medium reaction rate: group A (17.9%) was lower than group B (26.7%) and had no statistical significance (P=0.4210.05); group A (17.9%) was lower than group C (53.3%), and was statistically significant (P=0.0050.05); group B (26.7%) was lower than group C (53.3%), and had statistical significance (P=0.0350.05). The rate of good reaction (32.1%) was lower than group B (46.7%), and no statistical significance (P=0.2940.05 Group A (32.1%) was higher than group C (26.7%) and had no statistical significance (P=0.6470.05); group B (46.7%) was higher than group C (26.7%) and had no statistical significance (P=0.1080.05). The rate of reaction was very good: group A (46.4%) was higher than group B (20%) and was statistically significant (P= 0.0320.05); group A (46.4%) was higher than group C (6.7%) (P=0.0010.05); group B (20%) was compared with group C (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%). 6.7%) high, no statistical significance (P=0.1290.05). (4) there was no significant change of liver function before and after treatment. The common adverse reactions of ~ (89) Sr were myelosuppression (50%) and mild myelosuppression. The common side effects of zoledronic acid were digestive system symptoms (13.3%). The adverse events of the blood system: Grade 1: group A (28.6%) was higher than group B (6.7%), and had statistical significance (P=0. 270.05); group A (46.4%) was higher than group C (3.3%) (P=0.0080.05); group B (6.7%) was higher than group C (3.3%) and had no statistical significance (P=0.5540.05).2: group A (14.3%) was higher than group B (3.3%), no statistical significance (P=0.1380.05); group A (46.4%) was higher than group C (0%), and was statistically significant (P=0.0320.05); group B (3.3%) was higher than group C (0%), and no Statistical significance (P=0.3130.05).3: group A (7.14%) was higher than group B (0%), no statistical significance (P=0.1360.05); group A (7.14%) was higher than group C (0%), no statistical significance (P=0.1360.05); group B (0%) and C (0%) could not be compared. Conclusion: (1) the number of bone metastases in prostate cancer is reduced: ~ (89) Sr combined endocrine effect is obviously better than zoledronic acid Endocrine, independent endocrine curative effect. (2) the curative effect of bone pain relief: ~ (89) Sr combined endocrine effect is obviously better than zoledronic acid combined endocrine, independent endocrine effect. (3) after treatment pain index: the reaction is very good rate, ~ (89) Sr combined endocrine effect is obviously better than zoledronic acid combined endocrinology, individual endocrine effect; no reaction rate, There was no significant difference in the rate of moderate reaction. (4) 1 levels of adverse events in the blood system: ~ (89) Sr was more common than zoledronic acid; ~ (89) Sr adverse reactions were less than zoledronic acid. There was no significant change in liver function treatment.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25

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