转移性前列腺癌患者初始血清睾酮水平与预后相关指标的关系  

Relationship between initial serum testosterone levels and prognostic indicators in patients with metastatic prostate cancer

作　　者：卓涛 杨蝴蝶 安恒庆[1] 陶宁[3] 王玉杰[1] ZHUO Tao;YANG Hudie;AN Hengqing;TAO Ning;WANG Yujie(Urinary Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054;Graduate School of Xinjiang Medical University,Urumqi 830017;School of Public Health,Xinjiang Medical University,Urumqi 830017,China)

机构地区：[1]新疆医科大学第一附属医院泌尿中心,新疆乌鲁木齐830054 [2]新疆医科大学研究生学院,新疆乌鲁木齐830017 [3]新疆医科大学公共卫生学院,新疆乌鲁木齐830017

出　　处：《现代泌尿外科杂志》2024年第6期514-520,共7页Journal of Modern Urology

基　　金：新疆维吾尔自治区自然科学基金重点项目(No.2022D01D39);新疆维吾尔自治区自然科学基金杰出青年项目(No.2023D01E05);国家自然科学基金地区科学基金项目(No.82360476);新疆维吾尔自治区天山英才项目(No.2022TSYCCX0026)。

摘　　要：目的探讨初始血清睾酮水平与转移性前列腺癌(mPCa)侵袭性特征、进展和预后的相关性。方法回顾性分析2010年8月—2022年8月新疆医科大学第一附属医院收治的302例经穿刺病理及相关辅助检查诊断为mPCa患者的临床资料,其中初始血清睾酮低水平组(≤12 nmol/L)148例、正常组(>12 nmol/L)154例。采用多因素logistic回归分析与mPCa侵袭性特征相关的独立危险因素,Kaplan-Meier法进行生存分析,多因素Cox回归模型分析影响mPCa患者进展和预后的独立危险因素,通过受试者工作特征(ROC)曲线评估初始血清睾酮水平对mPCa患者进展和生存情况的预测价值。结果血清睾酮低水平组在Gleason评分≥8分、T分期>3、初始前列腺特异性抗原(PSA)>200 ng/mL、高瘤负荷、内脏转移和治疗6个月PSA≥0.2 ng/mL上的占比及身体质量指数(BMI)均高于正常组,但治疗6个月PSA下降率低于正常组(P<0.05)。多因素logistic回归分析显示初始血清睾酮水平>12 nmol/L是高瘤负荷(OR=0.137,95%CI:0.070~0.265,P<0.001)、Gleason评分≥8分(OR=0.371,95%CI:0.184~0.750,P=0.006)和内脏转移的保护性因素(OR=0.337,95%CI:0.175~0.652,P=0.001)。血清睾酮低水平组较正常组的中位无进展生存时间更短(15个月vs.20个月,P<0.001)、中位总生存时间(OS)也更短(45个月vs.86个月,P<0.001)。多因素Cox回归分析显示Gleason评分≥8分、高瘤负荷、治疗6个月时PSA值和PSA下降率是mPCa患者进展至去势抵抗性前列腺癌(CRPC)的独立影响因素(P<0.05),另外高瘤负荷患者死亡风险是低瘤负荷患者的2.510倍(95%CI:1.555~4.051,P<0.001)。ROC曲线显示初始血清睾酮水平在预测mPCa患者进展至CRPC风险(AUC:0.645)和死亡风险(AUC:0.595)中有一定价值。结论初始血清睾酮低水平与mPCa更高的侵袭性特征相关,并且可能与mPCa更差的预后有关,初始血清睾酮水平在预测mPCa患者进展风险和生存状态中也有一定意义。Objective To investigate the relationship between initial serum testosterone level and aggressive characteristics,progression and prognosis of metastatic prostate cancer(mPCa).Methods The clinical data of 302 mPCa patients diagnosed with biopsy and auxiliary examinations at the First Affiliated Hospital of Xinjiang Medical University during Aug.2010 and Aug.2022 were retrospectively analyzed,including 148 cases in the serum testosterone low level group(≤12 nmol/L)and 154 in the normal level group(>12 nmol/L).The independent risk factors associated with aggressive features were analyzed with multifactorial logistic regression,survival was determined with Kaplan-Meier method,the independent risk factors affecting progression and prognosis were identified with multifactorial Cox regression modeling,and the value of initial serum testosterone level in predicting the progression and survival was assessed with receiver operating characteristic(ROC)curve.Results The low level group had a higher proportion of Gleason score≥8,T stage>3,initial prostate-specific antigen(PSA)>200 ng/mL,high tumor load,visceral metastasis,PSA≥0.2 ng/mL after 6 months of treatment,and higher body mass index(BMI),but the PSA decline rate after 6 months of treatment was lower than that in the normal level group(P<0.05).Multifactorial logistic regression showed that initial serum testosterone level>12 nmol/L was a protective factor for high tumor load(OR=0.137,95%CI:0.070-0.265,P<0.001),Gleason score≥8(OR=0.371,95%CI:0.184-0.750,P=0.006)and visceral metastasis(OR=0.337,95%CI:0.175-0.652,P=0.001).The median progression-free survival was shorter in the low level group than in the normal level group(15 months vs.20 months,P<0.001),and the median overall survival time was also shorter(45 months vs.86 months,P<0.001).Multifactorial Cox regression analysis showed that Gleason score≥8,high tumor load,PSA value at 6 months of treatment,and PSA decline rate were independent influencing factors for progression to castration resistant prostate ca

关 键 词：睾酮 转移性前列腺癌 去势抵抗性前列腺癌 预后 

分 类 号：R737.25[医药卫生—肿瘤]