前列腺癌患者手术去势与药物去势的去势效果及相关不良反应比较的真实世界研究  

Real-world study on the comparison of castration effect and related side effects between surgical castration and drug castration in patients with prostate cancer

作　　者：陈彦君 刘丽 龚志勇[3] CHEN Yanjun;LIU Li;GONG Zhiyong(Department of Urology,The First People's Hospital of Guangyuan,Guangyuan,Sichuan,628000,China;Department of Dermatology,Guangyuan Central Hospital;Department of Urology,Affiliated Hospital of North Sichuan Medical College)

机构地区：[1]广元市第一人民医院泌尿外科,四川广元628000 [2]广元市中心医院皮肤科 [3]川北医学院附属医院泌尿外科

出　　处：《临床泌尿外科杂志》2023年第7期492-499,共8页Journal of Clinical Urology

摘　　要：目的:通过回顾性分析总结真实世界中手术去势与药物去势对前列腺癌患者的去势效果以及相关不良反应的影响,从而为前列腺癌患者内分泌治疗的选择提供现实指导。方法:收集2014年1月—2019年1月在川北医学院附属医院行手术去势(130例)和药物去势(114例)的前列腺癌患者资料,包括患者治疗前体重指数(body mass index,BMI)、空腹血糖(fasting blood glucose,FBG)、甘油三酯(triglyceride,TG)、血清总胆固醇(serum total cholesterol,TC)、尿酸(uric acid,UA)、高密度脂蛋白(high-density lipoprotein,HDL)、低密度脂蛋白(low-density lipoprotein,LDL)、前列腺特异性抗原(prostate specific antigen,PSA)、睾酮(testosterone,T)及Gleason评分等检验指标,并使用国际前列腺症状评分(IPSS)以及前列腺癌患者生活质量子量表(QLQ-PR25)进行相关评分,以手术日或第1次注射促黄体生成激素释放激素类似物(luteinizing hormone releasing hormone agonist,LHRHa)为随访起点,分别收集治疗后3、6、12个月检验指标及随访当日的相关评分,同时收集治疗后最低T、PSA最低值(PSA nadir,PSAn)以及到达最低值的时间。所有患者均经PSA、直肠指检、影像学检查及前列腺穿刺病理活检诊断。结果:本研究最终纳入患者244例,其中手术去势组130例,药物去势组114例。2组患者在年龄、BMI、FBG、TC、TG、UA、HDL、LDL、PSA、IPSS评分及QLQ-PR25评分差异均无统计学意义。治疗效果:2组患者在治疗3、6、12个月后PSA水平以及IPSS评分均呈不同程度的下降,2组在PSA下降幅度以及IPSS评分上差异无统计学意义(P=0.448、0.429、0.064;P=0.196、0.101、0.667);手术去势组和药物去势组从治疗开始到最低T时间分别为(7.18±1.27)d和(28.57±2.82)d,差异有统计学意义(P<0.001)。不良反应:手术去势组在治疗后胆固醇、TG与LDL呈逐步上升趋势,HDL在治疗后3个月出现下降,在治疗后12个月胆固醇、TG、LDL上升幅度明显,Objective To retrospectively analyze and summarize the effect of surgical castration and drug castration on the castration effect and related side effects of prostate cancer patients in the real world,so as to provide practical guidance for the choice of endocrine therapy for prostate cancer patients.Methods The data of patients with prostate cancer who underwent surgical castration(130 cases)and drug castration(114 cases)in the Affiliated Hospital of North Sichuan Medical College from January 2014 to January 2019 were collected,including pre-treatment body mass index(BMI),fasting blood glucose(FBG),triglyceride(TG),serum total cholesterol(TC),uric acid(UA),high-density lipoprotein(HDL),low-density lipoprotein(LDL),prostate-specific antigen(PSA),testosterone(T),Gleason score and other test indicators,and the International Prostate Symptom Score(IPSS)and the quality of life subscale for prostate cancer patients(QLQ-PR25)were used to score.The starting point of follow-up was the operation day or the first injection of luteinizing hormone releasing hormone analogue(LHRHa),Data from three,six,and 12 post-treatment months,the monthly test indicators and relevant scores on the day of follow-up,and the lowest T,PSA nadir(PSAn)and the time to reach the lowest value after treatment were collected.All patients were diagnosed by PSA,digital rectal examination,imaging examination and prostate biopsy.Results All 244 patients were finally included in this study,including 130 cases in the surgical castration group and 114 cases in the drug castration group.There was no significant difference in age,BMI,FBG,TC,TG,UA,HDL,LDL,PSA,IPSS score or QLQ-PR25 score between the two groups.Treatment effect:the PSA level and IPSS score of the two groups decreased in varying degrees after 3,6,and 12 months of treatment,and there was no significant difference in the decrease of PSA or IPSS score between the two groups(P=0.448,0.429,0.064;P=0.196,0.101,0.667);The time from the beginning of treatment to the lowest T in the surgical castration g

关 键 词：前列腺癌 去势治疗 不良反应 

分 类 号：R737.25[医药卫生—肿瘤]