去势抵抗性前列腺癌进展时间的预测因素分析

发布时间：2018-02-03 22:06

本文关键词： 去势抵抗性前列腺癌前列腺特异抗原疾病进展多因素分析　出处：《北京大学学报(医学版)》2017年04期 　论文类型：期刊论文

【摘要】：目的:探索前列腺癌经内分泌治疗后进入去势抵抗性前列腺癌(castration-resistant prostate cancer,CRPC)的预测因素,以更好地指导临床和提高患者预后。方法:回顾性分析了2003年1月至2014年12月在北京大学第一医院泌尿外科确诊前列腺癌并且初始治疗为内分泌治疗的患者共185例,收集并整理分析的临床信息包括患者年龄、前列腺癌TNM分期、前列腺癌病理Gleason评分(Gleason score,GS)、前列腺癌危险度、内分泌治疗开始时前列腺特异性抗原(prostate-specific antigen,PSA)水平、经过内分泌治疗后的PSA最低值、PSA下降速率以及降到PSA最低值的时间。应用Kaplan-Meier生存分析和log-rank检验比较不同分组间CRPC进展时间的差异,应用Cox风险比例回归模型来分析评估这些因素对CRPC进展时间的影响。结果:185例患者平均年龄(71.02±8.67)岁,CRPC进展的中位时间为38个月(4~158个月)。单因素分析中,前列腺癌T分期、N分期、前列腺癌危险度、内分泌治疗前是否发生远处转移、PSA下降速率和PSA最低值均与CRPC进展时间显著相关(P值均小于0.01)。在多因素分析中,内分泌治疗前已发生远处转移(HR=6.030,95%CI:3.229~11.263,P=0.001)、较高的PSA最低值(HR=1.185,95%CI:1.080~1.301,P=0.001)、PSA下降速率11μg/(L·month)(HR=2.124,95%CI:1.195~3.750,P=0.001)以及到达PSA最低值的时间≤9个月(HR=3.623,95%CI:1.640~4.817,P=0.004)均是CRPC进展时间较短的危险因素。结论:前列腺癌患者经过内分泌治疗后,PSA下降速率越快,进入CRPC时间越短。
[Abstract]:Objective: to explore the entry of castration-resistant prostate cancer into castration-resistant prostate cancer after endocrine therapy. The predictive factors of CRPCs. In order to better guide the clinical and improve the prognosis of patients. Methods:. A total of 185 patients with prostate cancer diagnosed in urology department of Peking University first Hospital from January 2003 to December 2014 and treated with endocrine therapy were retrospectively analyzed. The clinical information collected and analyzed included age, TNM stage of prostate cancer, and Gleason score of prostate cancer. Prostate cancer risk, prostate specific antigen prostate-specific antigen-PSAs at the start of endocrine therapy. The lowest value of PSA after endocrine therapy. Kaplan-Meier survival analysis and log-rank test were used to compare the difference of CRPC progression time among different groups. Cox risk proportional regression model was used to analyze and evaluate the effect of these factors on the progression time of CRPC. Results the average age of 185 patients was 71.02 卤8.67 years old. The median time for progression of CRPC was 38 months, 4 ~ 158 months. In univariate analysis, T staging, prostate cancer risk and distant metastasis occurred before endocrine therapy. The decrease rate of PSA and the lowest value of PSA were significantly correlated with CRPC progression time (P < 0.01). Distant metastases had occurred before endocrine therapy. HRT was 6.030 ~ 95 CI: 3.229 ~ 11.263P ~ (0.001), and the lowest value of PSA was 1.185. 95 CI: 1.080, 1.301, P0. 001. The rate of reduction of PSA was 11 渭 g / r / L 路month)(HR=2.124. 95 CI: 1.195 / 3.750 / P0. 001) and the time to reach the lowest value of PSA is less than 9 months (HR3.623). 95 CI: 1.640 / 4.817P0. 004) were all risk factors for shorter progression of CRPC. Conclusion: prostate cancer patients after endocrine therapy. The faster the decline rate of PSA is, the shorter the time to enter CRPC is.
【作者单位】：北京大学第一医院泌尿外科北京大学泌尿外科研究所国家泌尿男性生殖系肿瘤研究中心;
【基金】：首都临床特色应用研究(Z141107002514089) 吴阶平医学基金(320.6750.12273)资助~~
【分类号】：R737.25
【正文快照】： 无论是局限性晚期前列腺癌还是转移性前列腺癌,内分泌治疗都是最重要的治疗方式。虽然在内分泌治疗的初期针对前列腺癌的治疗效果较为显著,但是绝大多数患者在经过一定时间的内分泌治疗后都会从激素敏感性前列腺癌(hormone sensitiveprostate cancer,HSPC)进入去势抵抗性前列

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