前列腺癌ADT治疗期间PSA最低值的评估及临床意义  

Clinical Significance and Evaluation for Nadir PSA Level after ADT for Prostate Cancer

作　　者：杨堃[1] 王晖[1] 张峰[1] 江鱼[2] 

机构地区：[1]上海市杨浦区中心医院泌尿外科,上海200090 [2]上海交通大学医学院附属仁济医院泌尿外科

出　　处：《临床泌尿外科杂志》2009年第7期512-514,519,共4页Journal of Clinical Urology

摘　　要：目的:探讨PSA最低值在前列腺癌雄激素剥夺治疗(ADT)中的临床意义。方法:回顾性分析1999年6月～2007年6月间采用双侧睾丸切除术治疗71例前列腺癌患者的临床资料,按照治疗后PSA最低值可否达到0.2 ng/ml为界,将患者分为两组,并作多参数比较。结果:诊断时平均年龄76.0(56～90)岁。双侧睾丸切除术后随访时间(43.9±27.8)个月,45例(63.4%)患者的PSA最低值≤0.2 ng/ml,26例(36.6%)>0.2 ng/ml,两组平均PSA最低值差异有统计学意义(P<0.002)。两组患者达到PSA最低值的时间差异无统计学意义(P>0.5),但≤0.2 ng/ml组维持PSA最低值的时间间隔(33.88个月)比>0.2 ng/ml组(16.53个月)长(P<0.05),≤0.2 ng/ml组5年累积PSA无进展存活率显著高于>0.2 ng/ml组(对数秩和检验,x^2=8.68,P<0.005),临床进展率(22%)低于>0.2 ng/ml组(50%)(x^2=5.80,P<0.025),患者总存活时间(48.4个月)高于>0.2 ng/ml组(33.1个月)(t 2.22,P<0.05)。因前列腺癌死亡的患者中,≤0.2 ng/ml组平均存活时间(58.2个月)高于>0.2 ng/ml组(19.8个月)(t=6.29,P<0.001)。结论:ADT后PSA最低值可能是前列腺癌患者对ADT治疗敏感程度的重要预示物,PSA最低值越低,前列腺癌的预后越好。ADT后PSA最低值未达0.2 ng/ml的患者可能处于生化和临床进展的高危状态。Objective：To investigate the clinical value of nadir PSA level after ADT for prostate cancer. Methods：Reviewed clinical data of patients with prostate cancer treated with bilateral orchieetomy between June 1999 and June 2007. The patient swere divided into two groups based on whether nadir PSA level after ADT decreased to 0.2 ng/ml, and were made multivariate analysis. Results： 71 patients with a mean age of 76.0 years old （range 56 to 90） treated with bilateral orchiectomy were included in this study. Mean follow up was 43.9±27.8 months. 45 patients （63.4%） presented with nadir PSA level ≤0.2 ng/ml,and 26 （36.6%） 〉0.2 ng/ml. There were significant difference in mean nadir PSA levels between the two groups （P〈0. 002）. The interval until PSA level reached nadir after ADT was similar （P〉0.5）. However ≤0.2 ng/ml group provided a longer period free of nadir PSA level progression than 〉0.2 ng/ml group（P〈0.05）. Of the ≤0.2 ng/ml group the 5-year cumulative PSA progression-free survival was higher than 〉0.2 ng/ml group significantly （log rank test,x^2=8. 68,P〈 0. 005）, the clinical progression rate （22%） in PSA level lower than the 〉0.2 ng/ml group （50M） （x^2=5.80,P d0. 025）, overall survival time （48.4 months） longer than the 〉0.2 ng/ml group（33. 1 months） （t=2.22,P〈 0.05）. In patients died of prostate cancer a mean survival time for ≤0.2 ng/ml group（58.2 months） was longer than 2〉0.2 ng/ml group（19.8 months） （t=6.29 P〈0. 001）. Conclusions：The nadir PSA level after ADT may be an important predictor of the sensitive degree for ADT in patients with prostate cancer. The lower nadir PSA level is a better prognostic factor of prostate cancer. Patients whose nadir PSA level after ADT could not reach 0.2 ng/ ml have a higher risk of biochemical and clinical progress.

关 键 词：前列腺癌 雄激素剥夺治疗 前列腺特异抗原 

分 类 号：R737.25[医药卫生—肿瘤]