健脾利湿化瘀方联合内分泌治疗对转移性激素敏感性前列腺癌的治疗效果  

Therapeutic efficacy of spleen-invigorating,dampness-removing and stasis-dissolving formula combined with endocrinotherapy for metastatic hormone-sensitive prostate cancer

作　　者：郭姗琦[1] 孙彬栩[1] 姜行康[2] 杨同 贾英杰[1] 孔凡铭[1] Guo Shanqi;Sun Binxu;Jiang Xingkang;Yang Tong;Jia Yingjie;Kong Fanming(Department of Oncology,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381,China;Department of Urology,the Second Hospital of Tianjin Medical University,Tianjin 300211,China;Department of Urology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津中医药大学第一附属医院肿瘤科、国家中医针灸临床医学研究中心,天津300381 [2]天津医科大学第二医院泌尿外科,天津300211 [3]天津市第一中心医院泌尿外科,天津300192

出　　处：《肿瘤研究与临床》2024年第7期503-508,共6页Cancer Research and Clinic

基　　金：国家自然科学基金(82174174)。

摘　　要：目的探讨健脾利湿化瘀方联合内分泌治疗对转移性激素敏感性前列腺癌(mHSPC)的治疗效果。方法回顾性病例对照研究。回顾性分析2018年1月至2021年3月就诊于天津中医药大学第一附属医院、天津医科大学第二医院及天津市第一中心医院的193例mHSPC患者的临床资料。所有患者确诊后均接受持续内分泌治疗,根据治疗过程中是否联合健脾利湿化瘀方治疗分为联合治疗组(82例)和单独治疗组(94例)。比较两组前列腺特异性抗原(PSA)、血清睾酮、血脂(三酰甘油、总胆固醇)、空腹血糖、国际前列腺症状(I-PSS)评分、Karnofsky评分等。采用Kaplan-Meier法分析无进展生存(PFS),并进行log-rank检验。采用Cox比例风险模型对PFS的影响因素进行单因素及多因素分析。结果最终纳入176例mHSPC患者,年龄(67±11)岁;两组患者治疗前PSA、血清睾酮、三酰甘油、总胆固醇、空腹血糖、I-PSS评分、Karnofsky评分等比较,差异均无统计学意义(均P>0.05)。91例mHSPC患者进展为转移性去势抵抗性前列腺癌(mCRPC),其中单独治疗组51例、联合治疗组40例。9例死亡患者均为进展至mCRPC死亡。所有患者中位PFS时间为19个月,其中单独治疗组中位PFS时间为17.9个月,联合治疗组中位PFS时间为20.4个月,两组差异有统计学意义(P=0.001)。多因素Cox回归分析结果显示,联合健脾利湿化瘀方、最低睾酮值是PFS的独立影响因素(均P=0.001)。联合治疗组治疗6、9、12个月时总胆固醇均低于单独治疗组(均P<0.05),治疗3、6、9、12个月时三酰甘油均低于单独治疗组(均P<0.05);联合治疗组和单独治疗组治疗后不同时间点空腹血糖差异均无统计学意义(均P>0.05);联合治疗组治疗9、12个月时I-PSS评分均低于单独治疗组(均P<0.05)。结论健脾利湿化瘀方与内分泌治疗联合应用可延缓mHSPC疾病进展,改善治疗相关并发症,提高患者生命质量。Objective To investigate the therapeutic efficacy of spleen-invigorating,dampness-removing and stasis-dissolving formula(SDSF)combined with endocrinotherapy for metastatic hormone-sensitive prostate cancer(mHSPC).Methods A retrospective case control study was conducted.The clinical data of 193 mHSPC patients treated at First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,the Second Hospital of Tianjin Medical University,and Tianjin First Central Hospital from January 2018 to March 2021 were retrospectively analyzed.All patients were treated with continuous endocrinotherapy and they were divided into the combination therapy group(82 cases)and the monotherapy group(94 cases)based on whether they received SDSF treatment or not.Prostate specific antigen(PSA),serum testosterone,blood lipids(triglyceride,total cholesterol),fasting blood glucose,and international prostate symptoms score(I-PSS)and Karnofsky score were compared between the 2 groups.Kaplan-Meier method was used to analyze the progression-free survival(PFS),and log-rank test was performed.The Cox proportional risk model was used to make univariate analysis and multivariate analysis on the influencing factors of PFS.Results A total of 176 mHSPC patients were finally enrolled and the age was 67±11 years.There were no statistically significant differences in terms of PSA,serum testosterone,triglyceride,total cholesterol and fasting blood glucose,I-PSS score and Karnofsky score between the two groups(all P>0.05).A total of 91 mHSPC patients developed metastatic castration resistant prostate cancer(mCRPC),including the combination therapy group(40 cases)and the monotherapy group(51 cases),and 9 patients died because of the progression to mCRPC.The median PFS time of all patients was 19 months,that was 17.9 months in the monotherapy group and 20.4 months in the combination therapy group;and the difference was statistically significant between the 2 groups(P=0.001).Multivariate Cox regression analysis results showed that combination thera

关 键 词：前列腺肿瘤 肿瘤转移 方剂 内分泌系统 

分 类 号：R737.25[医药卫生—肿瘤]