CAJ | 학술논문

目的观察Gleason 10分前列腺癌患者的临床诊疗及疾病变化过程,总结该类前列腺癌患者的临床特点及预后影响因素. 方法 2005年1月至2010年5月,21例初诊为前列腺癌、Gleason 10分、行手术去势加抗雄激素治疗的患者纳入本研究.初诊年龄56～85岁,平均73岁.PSA 8.9～261.0 ng/ml,平均60.8 ng/ml,其中6例PSA≤20 ng/ml.行核素骨扫描发现骨转移16例.予双侧睾丸切除术加氟他胺或比卡鲁胺全雄激素阻断治疗.术后1个月复查PSA,以后每3个月随访PSA.治疗后6个月为单纯内分泌治疗观察终点.6个月内PSA未降至＜4 ng/ml且无远处转移者加用局部外放射治疗,伴骨转移者使用基于多西他赛与泼尼松的全身化疗.患者死亡为研究终点.结果 15例初诊PSA＞ 20 ng/ml患者中,5例治疗后6个月内血清PSA未降至正常水平,其中4例伴骨转移.该4例子全身化疗后PSA均未降至正常水平,3例1年内死亡,1例诊断后19个月死亡,1例疾病局限患者予外放射治疗,PSA下降至正常水平8个月后出现肿瘤进展,诊断后11个月死亡.10例治疗后6个月内血清PSA降至正常水平,其中3例分别于诊断后第19、28、36个月死于肿瘤,7例存活.6例初诊时PSA≤20 ng/ml患者中3例治疗后6个月内PSA未降至正常水平,其中2例伴骨转移予化疗后于1年内死亡;1例PSA下降至正常水平但仍出现肿瘤进展,全身多发骨转移,化疗无效,1年内死亡;1例4年后因前列腺癌死亡;1例随访6个月,PSA降至0.07 ng/ml. 结论 Gleason 10分前列腺癌肿瘤进展迅速,抗雄激素治疗疗效不佳,行伞雄激素阻断后6个月内PSA无法下降至正常水平患者病情进展凶险.初诊PSA≤20 ng/ml且病理证实Gleason 10分者可能预示预后不佳.
목적 관찰Gleason 10분전렬선암환자적림상진료급질병변화과정,총결해류전렬선암환자적림상특점급예후영향인소. 방법 2005년1월지2010년5월,21례초진위전렬선암、Gleason 10분、행수술거세가항웅격소치료적환자납입본연구.초진년령56～85세,평균73세.PSA 8.9～261.0 ng/ml,평균60.8 ng/ml,기중6례PSA≤20 ng/ml.행핵소골소묘발현골전이16례.여쌍측고환절제술가불타알혹비잡로알전웅격소조단치료.술후1개월복사PSA,이후매3개월수방PSA.치료후6개월위단순내분비치료관찰종점.6개월내PSA미강지＜4 ng/ml차무원처전이자가용국부외방사치료,반골전이자사용기우다서타새여발니송적전신화료.환자사망위연구종점.결과 15례초진PSA＞ 20 ng/ml환자중,5례치료후6개월내혈청PSA미강지정상수평,기중4례반골전이.해4례자전신화료후PSA균미강지정상수평,3례1년내사망,1례진단후19개월사망,1례질병국한환자여외방사치료,PSA하강지정상수평8개월후출현종류진전,진단후11개월사망.10례치료후6개월내혈청PSA강지정상수평,기중3례분별우진단후제19、28、36개월사우종류,7례존활.6례초진시PSA≤20 ng/ml환자중3례치료후6개월내PSA미강지정상수평,기중2례반골전이여화료후우1년내사망;1례PSA하강지정상수평단잉출현종류진전,전신다발골전이,화료무효,1년내사망;1례4년후인전렬선암사망;1례수방6개월,PSA강지0.07 ng/ml. 결론 Gleason 10분전렬선암종류진전신속,항웅격소치료료효불가,행산웅격소조단후6개월내PSA무법하강지정상수평환자병정진전흉험.초진PSA≤20 ng/ml차병리증실Gleason 10분자가능예시예후불가.
Objective To observe the clinical characteristic and treatment response of the Gleason 5 + 5 prostate cancer and to summarize the prognostic factor of such patients. Methods From January 2005 to May 2010,21 cases of Gleason 5 + 5 prostate cancer were enrolled in this study.The average age was 73 years and the pre-treatment PSA was 60.8 ng/ml.Six of the 21 cases had a PSA level ≤20 ng/ml.The maximal androgen deprivation therapy (ADT) in the form of castration and Casodex or fluctamide was carried out once the diagnosis was made.Bone metastasis was revealed in 16 cases.PSA levels were tested at the 4th month and then every 3 months after the castration.The observation endpoint was 6 months.Extracorporeal beam irradiation or the systemic chemotherapy was carried out if the PSA did not drop to a normal range after 6 months. Results In the study group with initial PSA ＞ 20 ng/ml,the PSA did not drop to normal range in 5 cases; of which 4 had bone metastasis.With systemic chemotherapy,3 cases died within 1 year.Another case,with localized disease,received an extracorporeal beam irradiation and died within 1 year due to progression of the tumor.Among the remaining 10 cases sensitive to total androgen blockage,7 survived through the end of the study period.One case had PSA recurrence in month seven after the initial therapy and died at month 19.One case had PSA recurrence at month 22 and died at month 36.The patient had his PSA augmented at month 24 after total androgen blockage and the patient passed away 4 months later.Of the 6 cases who had an initial PSA ≤20 ng/ml 4 died within one year. Conclusions Gleason 5 +5 prostate cancer is relatively resistant to ADT with a worse prognosis,especially for the cases with a nadir PSA ＞4 ng/ml after 6 months’ ADT.The patients who had an initial PSA ≤20 ng/ml might have an unsatisfactory clinical outcome.