前列腺癌晚期PSA水平变化及内分泌治疗的临床分析
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摘要
目的探究晚期前列腺癌患者血清PSA水平变化以及不同内分泌治疗方案的治疗效果。方法选取2009年2月至2012年6月当阳市人民医院诊治的晚期前列腺癌患者119例作为研究对象。按照内分泌治疗方案的不同分为IHT组(63例)和CHT组(56例)。对比两组患者在内分泌治疗后的PSA水平变化、临床疗效、药物不良反应以及生存质量状况。结果 HIT组患者在治疗后6个月的血清PSA水平明显高于CHT组,差异具有统计学意义(P<0.05),两组患者在治疗后12个月、18个月以及24个月的血清PSA水平均未见显著差异(P>0.05)。IHT组患者的排尿症状、治疗相关症状及性功能等方面评分明显优于CHT组,差异具有统计学意义(P<0.05),两组患者在肠道症状、骨痛方面评分差异无统计学意义(P>0.05)。IHT组患者在治疗期间的不良反应发生率为20.63%,明显高于CHT组(44.64%),差异具有统计学意义(P<0.05)。IHT组及CHT组患者的3年生存率分别为80.95%、76.19%,差异无统计学意义(P>0.05)。IHT组患者的出现进展以及处于去势抵抗的比例分别为23.81%、19.05%,均明显低于CHT组(分别为39.68%、41.27%),差异比较有统计学意义(P<0.05)。结论行间歇性内分泌治疗后,晚期前列腺的血清PSA水平逐渐趋于正常,能够获得与持续性内分泌治疗相同的临床疗效。间歇性内分泌治疗因其较低的药物不良反应能够使患者的的生存质量状况得到显著改善。
Objective To study the changes in serum PSA levels and therapeutic effects of different endocrine therapies for patients with advanced prostate cancer. Methods 119 patients with advanced prostate cancer who were treated with endocrine therapy in our hospital were selected as the research objects. According to the different endocrine treatment regimens, the patients were divided into IHT group(63 cases) and CHT group(56 cases). The changes in PSA levels, clinical efficacy, adverse reactions and quality of life were compared between the two groups after endocrine therapy. Results The serum PSA levels of IHT group were significantly higher than that in CHT group at 6 months after treatment(P<0.05). There were no significant differences in serum PSA levels between the two groups at 12 months, 18 months and 24 months after treatment(P>0.05). The urinary symptoms, treatment related symptoms and sexual function score in IHT group were significantly higher these in CHT group, with statistically significant difference(P<0.05). And there was no significant difference in the scores of intestinal symptoms and bone pain(P>0.05). The incidence of adverse reactions in IHT group was 20.63%, which was significantly higher than that in CHT group(44.64%), with statistically significant difference(P<0.05). The 3-year survival rates of IHT group and CHT group were 80.95% and 76.19% respectively, without statistically significant difference(P>0.05). The rates of progression and castration resistance in IHT group were 23.81% and 19.05% respectively, which were significantly lower than those in CHT group(39.68% and 41.27%, respectively), and the differences were statistically significant(P<0.05). Conclusions After intermittent hormonal therapy, the level of serum PSA decreases gradually and returns to normal level in the patients with advanced prostate cancer, with the same long-term effect as continuous hormonal therapy. Moreover, intermittent endocrine therapy can significantly improve the quality of life of patients because of its low adverse reactions.
Objective To study the changes in serum PSA levels and therapeutic effects of different endocrine therapies for patients with advanced prostate cancer. Methods 119 patients with advanced prostate cancer who were treated with endocrine therapy in our hospital were selected as the research objects. According to the different endocrine treatment regimens, the patients were divided into IHT group(63 cases) and CHT group(56 cases). The changes in PSA levels, clinical efficacy, adverse reactions and quality of life were compared between the two groups after endocrine therapy. Results The serum PSA levels of IHT group were significantly higher than that in CHT group at 6 months after treatment(P<0.05). There were no significant differences in serum PSA levels between the two groups at 12 months, 18 months and 24 months after treatment(P>0.05). The urinary symptoms, treatment related symptoms and sexual function score in IHT group were significantly higher these in CHT group, with statistically significant difference(P<0.05). And there was no significant difference in the scores of intestinal symptoms and bone pain(P>0.05). The incidence of adverse reactions in IHT group was 20.63%, which was significantly higher than that in CHT group(44.64%), with statistically significant difference(P<0.05). The 3-year survival rates of IHT group and CHT group were 80.95% and 76.19% respectively, without statistically significant difference(P>0.05). The rates of progression and castration resistance in IHT group were 23.81% and 19.05% respectively, which were significantly lower than those in CHT group(39.68% and 41.27%, respectively), and the differences were statistically significant(P<0.05). Conclusions After intermittent hormonal therapy, the level of serum PSA decreases gradually and returns to normal level in the patients with advanced prostate cancer, with the same long-term effect as continuous hormonal therapy. Moreover, intermittent endocrine therapy can significantly improve the quality of life of patients because of its low adverse reactions.
引文
[1] 刘春雷,崔涛,陈黎黎,等.内分泌联合维生素D应用于晚期前列腺癌的治疗探讨[J].中华肿瘤防治杂志,2016,23(S1):202-203.
[2] 徐瑞明,张占春,卢阳芳,等.老年中晚期前列腺癌同期调强放疗联合内分泌治疗的疗效观察[J].中国性科学,2016,25(3):27-29.
[3] 杜君,陈倩倩,杨庆.去势治疗诱导的神经内分泌前列腺癌的研究进展[J].中国肿瘤临床,2016,43(2):86-88.
[4] 何青峰,吴娟,张景宇,等.晚期前列腺癌患者间歇性内分泌治疗的疗效观察[J].中国癌症杂志,2015,25(12):989-993.
[5] 张立国,张金存,王磊,等.内分泌治疗和中药协同治疗对前列腺癌患者前列腺特异性抗原动态变化与疾病预后的相关分析[J].中华中医药学刊,2017,35(5):1333-1335.
[6] Patel D,Loh H,Le K,et al.Incidental detection of hepatocellular carcinoma on 68 Ga-Labeled prostate-specific membrane antigen PET/CT[J].Clin Nucl Med.2017,42(11):881-884.
[7] 姜良真,崔喆,王宝龙,等.间歇性内分泌治疗晚期前列腺癌的临床可行性及有效性[J].中国性科学,2017,26(6):5-7.
[8] 陈志雄,李黎明,刘晓龙,等.晚期前列腺癌间歇性和持续性内分泌治疗的效果比较及生活质量分析[J].山东医药,2015,55(25):75-77.
[9] 巩传凤,刘畅,王岚,等.老年中晚期前列腺癌同期调强放疗联合内分泌治疗的疗效[J].中国老年学杂志,2014,34(10):2744-2745.
[10] 王炜,李传刚,刘辉,等.前列腺特异性抗原对前列腺癌诊断价值的探讨[J].中国医科大学学报,2016,45(1):61-65+69.
[11] Okullo A,Penkoff P,Patel MI.Laboratory methods cause ultrasensitive prostate-specific antigen fluctuations[J].Anz J Surg.2017,87(9):651-652.
[12] 赵凯维,李冬梅,张华敏,等.中医药治疗前列腺特异性抗原(PSA)异常研究概述[J].中国中医基础医学杂志,2014,20(4):560-562.
[13] 林思进.前列腺癌患者对间歇性内分泌治疗的耐受性的影响因素[J].实用癌症杂志,2016,31(3):462-464.
[14] 张继伟,王海涛,何群,等.125I粒子植入联合间歇性内分泌治疗局部中高危前列腺癌的临床分析[J].中国性科学,2015,24(4):33-36.
[15] Tsai HT,Penson DF,Makambi KH,et al.Efficacy of intermittent androgen deprivation therapy vs conventional continuous androgen deprivation therapy for advanced prostate cancer:A meta-analysis[J].Urology,2013,82(2):327-334.
[16] 马海锋,张大海,郭冬,等.三维适形放疗联合内分泌治疗老年晚期前列腺癌临床疗效及对生活质量的影响[J].中国性科学,2015,24(3):18-21.
[17] 王海涛.去势抵抗性前列腺癌精准医学研究的探索[J].中国肿瘤临床,2015,42(17):850-855.
[18] 翟忠奇,罗晓辉,汤正岐,等.晚期前列腺癌间歇与持续性内分泌治疗的临床观察[J].现代肿瘤医学,2015,23(4):522-524.
[2] 徐瑞明,张占春,卢阳芳,等.老年中晚期前列腺癌同期调强放疗联合内分泌治疗的疗效观察[J].中国性科学,2016,25(3):27-29.
[3] 杜君,陈倩倩,杨庆.去势治疗诱导的神经内分泌前列腺癌的研究进展[J].中国肿瘤临床,2016,43(2):86-88.
[4] 何青峰,吴娟,张景宇,等.晚期前列腺癌患者间歇性内分泌治疗的疗效观察[J].中国癌症杂志,2015,25(12):989-993.
[5] 张立国,张金存,王磊,等.内分泌治疗和中药协同治疗对前列腺癌患者前列腺特异性抗原动态变化与疾病预后的相关分析[J].中华中医药学刊,2017,35(5):1333-1335.
[6] Patel D,Loh H,Le K,et al.Incidental detection of hepatocellular carcinoma on 68 Ga-Labeled prostate-specific membrane antigen PET/CT[J].Clin Nucl Med.2017,42(11):881-884.
[7] 姜良真,崔喆,王宝龙,等.间歇性内分泌治疗晚期前列腺癌的临床可行性及有效性[J].中国性科学,2017,26(6):5-7.
[8] 陈志雄,李黎明,刘晓龙,等.晚期前列腺癌间歇性和持续性内分泌治疗的效果比较及生活质量分析[J].山东医药,2015,55(25):75-77.
[9] 巩传凤,刘畅,王岚,等.老年中晚期前列腺癌同期调强放疗联合内分泌治疗的疗效[J].中国老年学杂志,2014,34(10):2744-2745.
[10] 王炜,李传刚,刘辉,等.前列腺特异性抗原对前列腺癌诊断价值的探讨[J].中国医科大学学报,2016,45(1):61-65+69.
[11] Okullo A,Penkoff P,Patel MI.Laboratory methods cause ultrasensitive prostate-specific antigen fluctuations[J].Anz J Surg.2017,87(9):651-652.
[12] 赵凯维,李冬梅,张华敏,等.中医药治疗前列腺特异性抗原(PSA)异常研究概述[J].中国中医基础医学杂志,2014,20(4):560-562.
[13] 林思进.前列腺癌患者对间歇性内分泌治疗的耐受性的影响因素[J].实用癌症杂志,2016,31(3):462-464.
[14] 张继伟,王海涛,何群,等.125I粒子植入联合间歇性内分泌治疗局部中高危前列腺癌的临床分析[J].中国性科学,2015,24(4):33-36.
[15] Tsai HT,Penson DF,Makambi KH,et al.Efficacy of intermittent androgen deprivation therapy vs conventional continuous androgen deprivation therapy for advanced prostate cancer:A meta-analysis[J].Urology,2013,82(2):327-334.
[16] 马海锋,张大海,郭冬,等.三维适形放疗联合内分泌治疗老年晚期前列腺癌临床疗效及对生活质量的影响[J].中国性科学,2015,24(3):18-21.
[17] 王海涛.去势抵抗性前列腺癌精准医学研究的探索[J].中国肿瘤临床,2015,42(17):850-855.
[18] 翟忠奇,罗晓辉,汤正岐,等.晚期前列腺癌间歇与持续性内分泌治疗的临床观察[J].现代肿瘤医学,2015,23(4):522-524.
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