基于倾向性评分匹配的新型内分泌药物新辅助治疗在寡转移前列腺癌中的临床应用研究  

Evaluation of Neoadjuvant Novel Hormonal Therapy for Oligometastatic Prostate Cancer Based on Propensity Score Matching Analysis

作　　者：曾凯 李强[2] 王涛[1] 刘博[3] 王勤章[2] 王少刚[1] 刘继红[1] Zeng Kai;Li Qiang;Wang Tao(Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Urology,the First Affiliated Hospital of Shihezi University,Shihezi 832008,China)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030 [2]石河子大学第一附属医院泌尿外科,石河子832008 [3]华中科技大学同济医学院附属同济医院肿瘤科,武汉430030

出　　处：《华中科技大学学报（医学版）》2023年第4期473-481,共9页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：新疆生产建设兵团科技计划项目(No.2021AB032)。

摘　　要：目的探讨新辅助内分泌联合新型内分泌治疗(NHNT)在寡转移前列腺癌(OMPCa)中的临床疗效。方法采用回顾性病例对照研究方法收集2015年1月至2020年12月在华中科技大学同济医学院附属同济医院行根治性前列腺切除术(RP)的OMPCa患者临床资料。根据治疗方案将患者分为标准治疗组(ST)103例,治疗方案为比卡鲁胺(50 mg/d)+醋酸亮丙瑞林(3.75 mg/28 d);新辅助内分泌组(NHT)71例,RP前接受比卡鲁胺(50 mg/d)+醋酸亮丙瑞林(3.75 mg/28 d)新辅助治疗3~6个月;新辅助新型内分泌组(NHNT)组45例,RP前接受醋酸阿比特龙(1000 mg/d)+泼尼松(5 mg/d)或恩杂鲁胺(160 mg/d)联合醋酸亮丙瑞林(3.75 mg/28 d)新辅助治疗3~6个月。运用Clavien-Dindo并发症分级方法评价NHT和NHNT组患者并发症发生率;采用倾向性评分匹配(PSM)法均衡组间混杂因素,统计学分析NHT和NHNT组患者术后临床病理特征变化、无影像进展生存期(rPFS)及各亚组间无去势抵抗生存期(crPFS)的差异。结果本研究共纳入219例OMPCa患者,PSM后53对患者分配至ST vs.NHT组、33对分配至ST vs.NHNT组、27对分配至NHT vs.NHNT组。14.66%(17/116)患者出现围手术期并发症,NHNT组前列腺特异性抗原应答率高于NHT组,术后分别有77.80%(21/27)和48.15%(13/27)患者PSA达到根治水平(P=0.047)。NHNT组肿瘤切缘阳性率较NHT组显著降低(P=0.042),但在淋巴结阳性、T分期及N分期降期方面两组比较无显著差异(均P>0.05)。NHT组和NHNT组中位rPFS分别为25和37个月,Cox回归分析结果显示NHNT可降低影像学进展风险[HR=0.480,95%CI(0.236~0.974),P=0.042]。crPFS亚组分析,ST和NHT组中位crPFS时间为22和26个月,差异无统计学意义(P=0.063);ST和NHNT组中位crPFS时间为24和30个月,NHNT可显著降低去势抵抗风险[HR=0.385,95%CI(0.168~0.882),P=0.024];NHT和NHNT组中位crPFS时间为26和32个月,NHNT可显著降低去势抵抗风险[HR=0.438,95%CI(0.218~0.897),P=0.020]。结论NHNT可降低OMPCa�Objective To investigate the clinical efficacy of neoadjuvant hormonal and novel hormone therapy(NHNT)in oligometastatic prostate cancer(OMPCa).Methods This study was designed as a retrospective,case-control study.The data of OMPCa patients treated in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2015to December 2020was collected.Patients were divided into three groups according to treatment options:standard treatment group(ST,bicalutamide 50mg per day and leuprolide acetate 3.75mg every 1months),neoadjuvant hormonal therapy group(NHT,bicalutamide 50mg per day and leuprolide acetate 3.75mg every 1months for 3-6months prior to RP)and neoadjuvant novel endocrine group(NHNT,Abiraterone acetate 1000mg per day+prednisone 5per day or enzalutamide 160mg per day combined with leuprolide acetate 3.75mg every 1months for 3-6months prior to RP).The complications were evaluated by Clavien-Dindo classification system.Propensity score matching(PSM)was used to control potential confounding variables.Postoperative clinicopathological features,progression-free survival(rPFS)and castration-resistant survival(crPFS)were statistically analyzed between NHT and NHNT groups.Results A total of 219OMPCa patients were included in this study,and 53pairs of patients with PSM were assigned to STvs.NHT group,33pairs were assigned to STvs.NHNT group,and 27 pairs were assigned to NHTvs.NHNT group.Perioperative complications occurred in 14.66%(17/116)patients.The prostatespecific antigen response rate in NHNT group was higher than that in NHT group,and PSA reached radical level after surgery in 77.80%(21/27)and 48.15%(13/27)patients,respectively(P=0.047).The positive rate of tumor resection margin in NHNT group was significantly lower than that in NHT group(P=0.042),but there were no significant differences in lymph node positive,T stage and N stage decline between the two groups(all P>0.05).The median rPFS in the NHT and NHNT groups were 25and 37months,respectively,and Cox regression analysis

关 键 词：前列腺癌 寡转移 新型内分泌治疗 新辅助治疗 倾向性评分匹配 

分 类 号：R737.25[医药卫生—肿瘤]