晚期前列腺癌去势治疗后进展成CRPC的危险因素分析  

Risk factors for CRPC progression after castration in advanced prostate cancer

作　　者：王建帮 李亚伟[1] 黄后宝[1] 江博研 程庆水[1] WANG Jianbang;LI Yawei;HUANG Houbao;JIANG Boyan;CHENG Qingshui(Department of Urology,Yijishan Hospital,Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院弋矶山医院泌尿外科,安徽芜湖241001

出　　处：《沈阳医学院学报》2020年第5期424-427,共4页Journal of Shenyang Medical College

摘　　要：目的:探究晚期前列腺癌患者去势治疗后进展成去势抵抗性前列腺癌(CRPC)的危险因素。方法:回顾性分析2013年6月至2018年6月191例皖南医学院弋矶山医院收治的行去势治疗的晚期前列腺癌患者的临床资料,Gleason评分中位值8分,初始前列腺特异性抗原(PSA)、初始游离前列腺特异性抗原(fP SA)中位值分别为71.11、9.07 ng/ml,治疗前平均血红蛋白(Hb)、治疗前白蛋白(ALB)分别为109、34.0 g/L,治疗前平均碱性磷酸酶(ALP)103 U/L,临床分期>T2b期151例;78例手术去势治疗加抗雄治疗,113例药物去势治疗加抗雄治疗。采用多因素Cox回归分析晚期前列腺癌患者去势治疗后进展成CRPC的危险因素。结果:191例患者随访时间为6~73个月,中位值为15个月。去势治疗后104例进展为CRPC,进展成CRPC的中位时间12个月(6~40个月)。多因素Cox回归分析显示,初始PSA值(OR=2.172,95%CI:1.215~3.882)、Gleason评分(OR=1.645,95%CI:1.089~2.484)、治疗前Hb值(OR=0.476,95%CI:0.310~0.732)、治疗前ALB(OR=0.405,95%CI:0.265~0.62)、治疗前ALP(OR=1.712,95%CI:1.147~2.557)是晚期前列腺癌去势治疗后进展至CRPC的高危因素(P<0.05)。结论:初始PSA值、Gleason评分以及治疗前Hb值、ALB、ALP是晚期前列腺癌经去势治疗后进展为CRPC的危险因素。晚期前列腺癌患者去势治疗前PSA值越高、Gleason评分越高、Hb值及ALB值越低,ALP越高则进展至CRPC的可能越大。Objective:To investigate the risk factors of castration-resistant prostate cancer(CRPC)in patients with advanced prostate cancer after castration.Methods:Clinical data of 191 patients with advanced prostate cancer treated with castration in our hospital from Jun 2013 to Jun 2018 were retrospectively analyzed.The middle Gleason score was 8(5-10),the middle PSA and fP SA at the initiation of hormone therapy(HT)was 71.11(1.20-100.00)ng/ml and 9.07(0.29-30.00)ng/ml,the mean hemoglobin level was 109(56-161)g/L,the mean albumin level was 34.0(16.4-55.0)g/L,the mean alkaline phosphatase level was 103(28-371)U/L.And 151 patients(79.1%)were later than clinical T2 b,78 patients(40.8%)received surgical castration,113 patients(59.2%)received chemical castration.The relationship between CRPC and these risk factors was analyzed by multivariate Cox regression analysis method.Results:The middle follow-up time was 15(6-73)months.After HT treatment,104 cases progressed to CRPC,and the median time of progression to CRPC was 12(6-40)months.Multivariate Cox regression analysis showed that PSA at the initiation of HT(OR=2.172,95%CI:1.215-3.882),Gleason score(OR=1.645,95%CI:1.089-2.484),hemoglobin level(OR=0.476,95%CI:0.310-0.732),albumin level(OR=0.405,95%CI:0.265-0.62),alkaline phosphatase level(OR=1.712,95%CI:1.147-2.557)were found to be significantly associated with the rapid progression to CRPC(P<0.05).Conclusion:Patients with higher PSA at the initiation of HT,higher Gleason score,lower hemoglobin level,lower albumin level,higher alkaline phosphatase level are more likely to progress to CRPC.

关 键 词：前列腺癌 前列腺特异抗原 去势抵抗 多因素分析 

分 类 号：R737.25[医药卫生—肿瘤]