發(fā)布時(shí)間：2018-02-03 22:06

  本文關(guān)鍵詞： 去勢(shì)抵抗性前列腺癌 前列腺特異抗原 疾病進(jìn)展 多因素分析　出處：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年04期 　論文類型：期刊論文

【摘要】：目的:探索前列腺癌經(jīng)內(nèi)分泌治療后進(jìn)入去勢(shì)抵抗性前列腺癌(castration-resistant prostate cancer,CRPC)的預(yù)測(cè)因素,以更好地指導(dǎo)臨床和提高患者預(yù)后。方法:回顧性分析了2003年1月至2014年12月在北京大學(xué)第一醫(yī)院泌尿外科確診前列腺癌并且初始治療為內(nèi)分泌治療的患者共185例,收集并整理分析的臨床信息包括患者年齡、前列腺癌TNM分期、前列腺癌病理Gleason評(píng)分(Gleason score,GS)、前列腺癌危險(xiǎn)度、內(nèi)分泌治療開(kāi)始時(shí)前列腺特異性抗原(prostate-specific antigen,PSA)水平、經(jīng)過(guò)內(nèi)分泌治療后的PSA最低值、PSA下降速率以及降到PSA最低值的時(shí)間。應(yīng)用Kaplan-Meier生存分析和log-rank檢驗(yàn)比較不同分組間CRPC進(jìn)展時(shí)間的差異,應(yīng)用Cox風(fēng)險(xiǎn)比例回歸模型來(lái)分析評(píng)估這些因素對(duì)CRPC進(jìn)展時(shí)間的影響。結(jié)果:185例患者平均年齡(71.02±8.67)歲,CRPC進(jìn)展的中位時(shí)間為38個(gè)月(4~158個(gè)月)。單因素分析中,前列腺癌T分期、N分期、前列腺癌危險(xiǎn)度、內(nèi)分泌治療前是否發(fā)生遠(yuǎn)處轉(zhuǎn)移、PSA下降速率和PSA最低值均與CRPC進(jìn)展時(shí)間顯著相關(guān)(P值均小于0.01)。在多因素分析中,內(nèi)分泌治療前已發(fā)生遠(yuǎn)處轉(zhuǎn)移(HR=6.030,95%CI:3.229~11.263,P=0.001)、較高的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)以及到達(dá)PSA最低值的時(shí)間≤9個(gè)月(HR=3.623,95%CI:1.640~4.817,P=0.004)均是CRPC進(jìn)展時(shí)間較短的危險(xiǎn)因素。結(jié)論:前列腺癌患者經(jīng)過(guò)內(nèi)分泌治療后,PSA下降速率越快,進(jìn)入CRPC時(shí)間越短。
[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 鹵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.
【作者單位】： 北京大學(xué)第一醫(yī)院泌尿外科北京大學(xué)泌尿外科研究所國(guó)家泌尿男性生殖系腫瘤研究中心;
【基金】：首都臨床特色應(yīng)用研究(Z141107002514089) 吳階平醫(yī)學(xué)基金(320.6750.12273)資助~~
【分類號(hào)】：R737.25
【正文快照】： 無(wú)論是局限性晚期前列腺癌還是轉(zhuǎn)移性前列腺癌,內(nèi)分泌治療都是最重要的治療方式。雖然在內(nèi)分泌治療的初期針對(duì)前列腺癌的治療效果較為顯著,但是絕大多數(shù)患者在經(jīng)過(guò)一定時(shí)間的內(nèi)分泌治療后都會(huì)從激素敏感性前列腺癌(hormone sensitiveprostate cancer,HSPC)進(jìn)入去勢(shì)抵抗性前列

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