转移性前列腺癌早期去势抵抗的预测因素分析  

Early castration resistant prostate cancer:analysis of prognostic factors

作　　者：徐凡[1] 董柏君[1] 潘家骅[1] 沙建军[1] 温晓飞[2] 刘辉 吴鹏飞 薛蔚[1] 黄翼然[1] 

机构地区：[1]上海交通大学医学院附属仁济医院泌尿外科,上海200127 [2]上海市东方医院泌尿外科,上海200120 [3]上海市浦东新区周浦医院泌尿外科,上海201318 [4]上海市浦东新区光明中医医院泌尿外科,上海201300

出　　处：《现代泌尿外科杂志》2015年第2期80-85,共6页Journal of Modern Urology

基　　金：浦东新区卫生系统重点学科群建设(No.PWZxq2014-05);上海市科委(No.14140901700);国家自然科学基金(No.91129725)

摘　　要：目的探讨转移性前列腺癌全雄阻断后去势抵抗（CRPC）进展的预测因素及其早期发生的影响因素。方法回顾性分析102例全雄阻断治疗的前列腺癌骨转移患者的临床资料。采用Log rank检验和Cox回归分析治疗后发生CRPC的预测因素。采用非参数检验、χ^2检验、Logistic回归分析早期发生CRPC（1年内）的影响因素。结果入组患者平均随访时间为21.4±13.3个月,中位CRPC发生时间为25.5月。Gleason评分（HR：2.100;95%CI：1.236-3.567;P=0.006 1）、全雄阻断治疗后PSA最低值（HR：5.287,95%CI：2.816-9.924;P〈0.0001）、到达PSA最低值时间（HR：0.275;95%CI：0.137-0.554;P=0.008 7）是发生CRPC的独立预测因子。其中到达最低值时间（OR：0.672;95%CI：0.497-0.908）是早期发生CRPC的独立影响因素。结论Gleason评分≥9分、治疗后PSA最低值≥0.2ng/mL、到达最低值时间〈9月的患者对单纯全雄阻断治疗反应不佳,特别是治疗后到达PSA最低值时间短的患者,早期CRPC发生可能大。Objective To explore the prognostic factors of early castration resistant prostate cancer（CRPC）after maximal androgen blockade（MAB）in metastatic prostate cancer.Methods Clinical data of 102 patients with bone metastatic prostate cancer who received MAB in Shanghai Renji Hospital during 2010 and 2012 were retrospectively reviewed.Log rank test and Cox regression were used to analyze the prognostic factors of CRPC.Non-parametric test,chi-square test and Logistic regression were used to analyze the influencing factors of early CRPC（within one year after MAB）.Results The average follow-up was 21.4±13.3 months,median CRPC time was 25.5 months.Gleason score（HR：2.100;95%CI：1.236-3.567;P=0.006 1）,PSA nadir value（HR：5.287,95%CI：2.816-9.924;P0.000 1）and time to PSA nadir（HR：0.275;95%CI：0.137-0.554;P=0.008 7）were all independent prognostic factors of CRPC.The interval time to nadir was the independent influencing factor of early CRPC after MAB（OR：0.672;95%CI：0.497-0.908）.Conclusions Bone metastatic prostate cancer with one or more of the following characters indicates a poor responses to pure MAB therapy：Gleason score≥9,PSA nadir value after MAB ≥0.2 ng/mL and time to PSA nadir less than9 months.Patients who have short interval time to nadir are more likely to have CRPC within one year.

关 键 词：前列腺癌 内分泌治疗 全雄激素阻断 去势抵抗 预测因素 

分 类 号：R737.25[医药卫生—肿瘤]