抗雄激素药物撤退治疗雄激素非依赖性晚期转移性前列腺癌的疗效分析与预测  

Effect and predictive factors of anti-androgen withdrawal in the treatment of androgen independent prostate cancer

作　　者：马春光[1] 叶定伟[1] 姚旭东[1] 张世林[1] 戴波[1] 张海梁[1] 朱耀[1] 沈益君[1] 朱一平[1] 施国海[1] 秦晓健[1] 林国文[1] 肖文军[1] 杨立峰[1] 杨柏帅[1] 曹达龙[1] 

机构地区：[1]复旦大学附属肿瘤医院泌尿外科,复旦大学上海医学院肿瘤学系,200032

出　　处：《中华泌尿外科杂志》2010年第12期847-851,共5页Chinese Journal of Urology

摘　　要：目的 寻找预测抗雄激素药物撤退治疗雄激素非依赖性晚期转移性前列腺癌有效性的相关因素.方法 晚期转移性前列腺癌患者347例,均接受最大程度雄激素阻断治疗.其中失效进展为雄激素非依赖性前列腺癌（AIPC）237例,接受抗雄激素药物撤退治疗90例.对90例患者进行随访,末次随访时间2009年9月30日.将内分泌治疗前基线血清PSA、Gleason评分（GS）、临床分期、去势方案、抗雄激素药物方案、内分泌治疗过程中血清PSA最低值、达到PSA最低值时间、进展为AIPC时PSA速率（PSAV）、进展为AIPC时PSA倍增时间（PSADT）、内分泌治疗有效时间、进展为AIPC时年龄、抗雄激素药物撤退治疗前PSA作为预测抗雄激素药物撤退治疗是否有效的预测因素,行Logistic单因素及多因素回归分析.结果 90例患者中具有完整随访资料87例,其中有效17例（19.5%）,无效70例（80.5%）.至末次随访时,失效14例,仍有效3例.抗雄激素药物撤退治疗中位有效时间4个月.单因素分析结果显示,进展为AIPC时PSAV（P=0.033）、进展为AIPC时PSADT（P=0.009）和抗雄激素药物撤退治疗前PSA（P=0.002）为抗雄激素药物撤退治疗有效性的预测因素.多因素分析结果显示：进展为AIPC时PSAV（P=0.042）和PSADT（P=0.036）为抗雄激素药物撤退治疗有效性的独立预测因素.结论 进展为AIPC时PSAV和PSADT为预测抗雄激素药物撤退治疗有效性的独立预测因素.Objective To analyze the predictive factors of anti-androgen withdrawal in the treatment of androgen independent prostate cancer. Methods 347 cases of advanced metastatic prostate cancer in our prostate cancer database were filtered. All the cases were treated with maximal androgen blockade and had full pathological and clinical information. 237 cases developed to the androgen independent stage during the maximal androgen blockade treatment. Among them, 90 cases were treated with anti-androgen withdrawal. This 90 cases were followed up and the last follow-up date was 30 September 2009. The Logistic regression of univariate and multivariate analysis were used to find the predictive factors for the effectiveness of anti-androgen withdrawal, which including baseline PSA, Gleason score, clinical stage, way of castration, kind of anti-androgen, PSA nadir during maximal androgen blockade, time to PSA nadir, PSAV at the time of AIPC, PSADT at the time of AIPC, the effective duration of maximal androgen blockade, age at the time of AIPC and PSA at the initiation of anti-androgen withdrawal. Results Of the 90 cases treated with anti-androgen withdrawal, 3 cases were excluded for analysis because of the incomplete information. Among the 87 cases, 17 cases were effective with the anti-androgen withdrawal treatment while the other 70 cases were ineffective. At the last follow-up, 3 cases were still effective. The median effective duration of anti-androgen withdrawal was 4 months. The univariate analysis indicated that PSAV at the time of AIPC （P=0.033）, PSADT at the time of AIPC （P=0.009） and PSA at the initiation of anti-androgen withdrawal （P=0.002）were predictive factors. The multivariate analysis indicated that PSAV （P=0.042） and PSADT at the time of AIPC （P= 0.036） were independent predictive factors for the effectiveness of anti-androgen withdrawal. Conclusions Among the androgen independent advanced metastatic prostate cancer patient, there were about 19. 5% cases effective with the anti-androgen w

关 键 词：前列腺肿瘤 癌 雄激素类 

分 类 号：R686[医药卫生—骨科学]