镭-223治疗伴与不伴同源重组修复基因突变mCRPC患者的有效性和安全性比较  

The efficacy and safety comparison of radium-223 in the treatment of mCRPC patients with and without homologous recombination repair gene mutation

作　　者：夏斌彬 杜新星 樊连城 迟辰斐 朱寅杰[1] 潘家骅[1] 董柏君[1] 薛蔚[1] Xia Binbin;Du Xinxing;Fan Liancheng;Chi Chenfei;Zhu Yinjie;Pan Jiahua;Dong Baijun;Xue Wei(Department of Urology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿科,上海200127

出　　处：《中华泌尿外科杂志》2023年第5期330-336,共7页Chinese Journal of Urology

基　　金：上海市科委科研计划项目(19411967400)。

摘　　要：目的比较镭-223治疗伴与不伴同源重组修复(HRR)基因突变的转移性去势抵抗性前列腺癌(mCRPC)患者的有效性和安全性。方法回顾性分析2021年4月至2022年11月于上海交通大学医学院附属仁济医院接受镭-223治疗的27例mCRPC骨转移患者的临床资料。其中伴HRR基因突变者18例,为同源重组修复缺陷(HRD)(+)组;无HRR基因突变者9例,为HRD(-)组。HRD(+)组患者年龄69.5(63.8,77.0)岁,碱性磷酸酶(ALP)243.0(82.8,301.3)U/L,前列腺特异性抗原(PSA)71.6(7.3,329.8)ng/ml,疼痛评分3.0(1.0,5.0)分;美国东部肿瘤协作组(ECOG)评分0~1分7例2分11例。HRD(-)组患者年龄72.0(64.5,76.5)岁,ALP88.0(67.5,260.6)U/L,PSA19.1(1.1,117.8)ng/ml,疼痛评分2.0(0,4.5)分;ECOG评分0~1分4例,2分5例。两组上述一般资料差异均无统计学意义(P>0.05)。所有患者每4周接受1次镭-223治疗,不超过6次。比较两组患者治疗前后ALP、PSA、疼痛评分、血液学不良反应情况。结果HRD(+)组镭-223中位治疗次数4.5(3.0,5.3)次,4例(22.2%)治疗6次,6例(33.3%)随访过程中死于前列腺癌;HRD(-)组中位治疗次数4.0(2.5,6.0)次,3例(33.3%)完成6次治疗,1例(11.1%)随访过程中死于前列腺癌。两组治疗次数差异无统计学意义(P=0.320)。HRD(+)组治疗后ALP为101.8(61.3,147.0)U/L,较治疗前显著下降(P=0.002);HRD(-)组治疗后ALP为(73.064.0,113.5)U/L,与治疗前差异无统计学意义(P=0.327)。HRD(+)组的ALP反应(ALP较治疗前下降>10%)率显著高于HRD(-)组[83.3%(15/18)与44.4%(4/9),P=0.037]。治疗后HRD(+)组PSA为105.9(5.2,798.4)ng/ml,HRD(-)组为25.6(0.8,1031.0)ng/ml,与治疗前差异均无统计学意义(P=0.145,P=0.386);HRD(+)组与HRD(-)组的PSA反应(PSA较治疗前下降>10%)率差异无统计学意义[38.9%(7/18)与22.2%(2/9),P=0.386]。HRD(+)组治疗后中位疼痛评分3.0(0,4.0)分,较治疗前显著下降(P=0.028);HRD(-)组治疗后疼痛评分1.0(0,3.0)分,与治疗前差异无统计学意义(P=0.129)。HRD(+)组疼痛缓解率与HRD(-)组�Objective To compare the efficacy and safety of radium-223 in the treatment of metastatic castration-resistant prostate cancer(mCRPC)patients with and without homologous recombination repair(HRR)gene mutation.Methods The clinical data of 27 patients with mCRPC bone metastases who received radium-223 therapy from April 2021 to November 2022 in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine were retrospectively analyzed.Among the 27 mCRPC patients,18 patients carrying HRR gene mutations belonged to the HRD(+)group,and 9 patients without HRR gene mutation belonged to the HRD(-)group.The age of patients in HRD(+)group was 69.5(63.8,77.0)years old,alkaline phosphatase(ALP)was 243.0(82.8,301.3)U/L,prostate specific antigen(PSA)was 71.6(7.3,329.8)ng/ml,pain score was 3.0(1.0,5.0)points.Easterm Cooperative Oncology Group(ECOG)score ranged from O to 1 points in 7 cases,and 2 points in 11 cases.In the HRD(-)group,the median age was 72.0(64.5,76.5)years old,ALP was 88.0(67.5,260.6)U/L,PSA was 19.1(1.1,117.8)ng/ml,and pain score was 2.0(0,4.5)points.The ECOG score ranged from 0 to 1 in 4 cases,and 2 in 5 cases in the HRD(-)group.There was no significant difference in the above general data between the two groups(P>0.05).All patients received radium-223 treatment every 4 weeks,no more than 6 times.The changes of ALP,PSA,pain score and hematological adverse reactions were compared between the two groups.Results In the HRD(+)group,the median number of radium-223 treatment was 4.5(3.0,5.3)couses,4 patients(22.2%)completed 6 courses,and 6 patients died of prostate cancer during follow-up.In the HRD(-)group,the median number of radium treatment was 4.O(2.5,6.0)couses,3 patients(33.3%)completed 6 courses,and 1 patient died of prostate cancer during follow-up.There was no significant difference in the number of radium treatment courses between the two groups(P=0.320).ALP in HRD(+)group was 101.8(61.3,147.0)U/L after radium-223 treatment,which was significantly lower than that before treatment(P=0.002).A

关 键 词：前列腺肿瘤 癌 转移性 去势抵抗 镭-223 同源重组修复基因突变 

分 类 号：R737.25[医药卫生—肿瘤]