转移性去势抵抗性前列腺癌阿比特龙治疗后闪烁现象的临床特征和预后  

The clinical characters and prognostic value of flare phenomenon in metastatic castration resistant prostate cancer patients treated with Abiterone

作　　者：杨涛 刘莺[1] 陈淑珍[2] 秦婴逸 吴登龙[1] 卞崔冬[1] 蒋挺[4] 刘锋[4] 徐成党 王新安 迟永楠 黄盛松[1] Yang Tao;Liu Ying;Chen Shuzhen;Qin Yingyi;Wu Denglong;Bian Cuidong;Jiang Tin;Liu Feng;Xu Chengdang;Wang Xin'an;Chi Yongnan;Huang Shengsong(Department of Urology,Tongji Hospital,School of Medicine,Tongji University,Shanghai 200065,China;Department of Nuclear Medicine,Tongji Hospital,School of Medicine,Tongji University,Shanghai 200065,China;Department of Health Statistics,Naval Medical University,Shanghia2i00433,China;Department of Urology,First Peoples Hospital of Taicang,Taicang 215400,China)

机构地区：[1]同济大学附属同济医院泌尿外科,上海200065 [2]同济大学附属同济医院核医学科,上海200065 [3]海军军医大学卫勤系军队卫生统计学教研室,上海200433 [4]江苏省太仓市第一人民医院泌尿外科,太仓215400

出　　处：《中华泌尿外科杂志》2023年第12期911-916,共6页Chinese Journal of Urology

基　　金：上海市自然科学基金项目(21ZR1458300);上海市级医院新兴前沿技术联合攻关项目(SHDC12019112)。

摘　　要：目的分析转移性去势抵抗性前列腺癌(mCRPC)醋酸阿比特龙(AA)治疗后出现前列腺特异性抗原(PSA)闪烁和骨闪烁的临床特征,探讨闪烁现象对患者预后的影响。方法回顾性分析2016年7月至2020年12月同济大学附属同济医院收治的93例mCRPC患者的临床资料。年龄(75.4±8.9)岁,PSA58.2(16.4,148.6)ng/ml。患者应用AA1000mg每日1次+泼尼松5mg每日2次治疗。PSA闪烁定义为AA治疗后PSA持续上升1~2个月后下降;骨闪烁定义为治疗后第3个月骨扫描检查提示骨转移灶数量或范围增加,继续治疗6~9个月后复查提示骨转移灶数量减少或稳定。分析发生闪烁现象患者的临床特征和对患者无疾病进展生存期(PFS)和总生存期(OS)的影响。结果本组93例,中位随访时间16(6,54)个月。14例(15.1%)发生PSA闪烁,持续时间2(1,7)个月;7例(7.5%)发生骨闪烁,其中3例伴PSA闪烁。PSA闪烁患者治疗后1个月的血清碱性磷酸酶高于治疗前[119.0(97.0,288.8)U/L与115.5(98.0,198.5)U/L,P=0.016]。多因素Cox回归分析结果显示,骨闪烁是PFS的保护性因素(HR=0.117,95%CI0.015~0.895,P=0.039);PSA闪烁与PFS(HR=1.314,95%CI 0.554~3.121,P=0.536)和0S(HR=1.348,95%CI 0.393~4.263,P=0.635)无相关性。log-rank检验结果显示,骨闪烁患者的PFS[未达到与13.0(95%CI10.3~15.7)个月,P=0.016]和0S[未达到与24.0(95%CI22.1~25.8)个月,P=0.047]优于无骨闪烁患者。结论闪烁现象在AA治疗的mCRPC患者中并不罕见,PSA闪烁多在持续治疗1~2个月后出现PSA下降,对患者预后无显著影响;发生骨闪烁预示AA治疗具有更好的疗效。Objective To investigate the clinical characters and prognostic value of PSA flare and bone flare in metastatic castration resistant prostate cancer(mCRPC)patients received Abiterone acetate(AA)therapy.Methods A retrospective study was conducted for 93 mCRPC patients treated with AA from Jul.2016 to Dec.2020.Mean age was(75.4±8.9)years,median PSA was 58.2(16.4,148.6)ng/ml.Patients received at least 6 months of AA treatment.PSA flare was defined as an increase of PSA afer AA therapy followed by a decrease.Bone flare was defined as disease progression after 3 months of therapy,typically based on increased lesion intensity or number,and reevaluation 6-9 months later showed improvement in the scan.The clinical characters and prognostic value of the flare phenomenon was evaluated and analyzed respectively.Results The median follow up time was 16 months(6,54 months),fourteen patients showed PSA flare at first month after AA treatment,and median time of duration was 2 months(1,7 months).The serum alkaline phosphatase(ALP)had a similar rising trend along with PSA flare[115.5(98.0,198.5)U/L vs.119.0(97.0,288.8)U/L,P=0.016].Seven patients showed bone flare and 3 cases co-existed with PSA flare.Multivariate Cox regression analysis indicated bone flare was an independent protective factor for progression free survival(PFS)(HR=0.117,95%CI 0.015-0.895,P=0.039),PSA flare had no significant influence on PFS(HR=1.314,95%CI 0.554-3.121,P=0.536)and overall survival(OS)(HR=1.348,95%CI 0.393-4.263,P=0.635).Log-rank test showed patients with bone flare had a longer PFS(P=0.016)and OS(P=0.047)compared with patients without bone flare.Conclusions PSA flare always faded away after 2 months AA therapy and had no influence on PFS and OS.Bone flare maybe an indication for better prognosis.

关 键 词：前列腺肿瘤 癌 去势抵抗 阿比特龙 闪烁 

分 类 号：R737.25[医药卫生—肿瘤]