CAJ | 학술논문

目的探讨转移性前列腺癌的预后及相关因素. 方法转移性前列腺癌患者32例.平均年龄71(54～87)岁.均经直肠标准6点前列腺穿刺活检证实为前列腺癌,阳性点数1～2点4例、3～4点7例、5～6点21例.Gleason评分2～6分2例、7分19例、8～10分11例.临床分期T_(1-2c)N_1M_0 6例、T_(2c)N_1M_1 1例、T_(3a)N_1 M_1 13例、T_(3a)N_2 M_1 2例、T(3b)N_1 M_1 5例、T_(3b)N_2 M_1 1例、T_4N_1 M_1 4例.治疗前血清PSA值63～2000 ng/ml,中位数158 ng/ml;血清睾酮平均11.4(4.4～50.7)nmol/L.骨转移27例,其中合并盆腔淋巴结转移8例,单纯淋巴结转移5例.采用手术去势加雄激素阻断(比卡鲁胺50 mg/d或氟他胺250 mg 3次/d)治疗.一线内分泌治疗时间7～48个月,中位时间23个月.一线内分泌治疗失败后,改用己烯雌酚或雌二醇氮芥治疗,41%的患者对二线内分泌治疗不敏感,59%的患者对二线治疗有效,持续时间3～15个月.统计学分析患者预后与治疗前各指标的相关性. 结果 32例患者平均随访33(13～98)个月.28例确诊后13～86个月死亡.存活4例,随访78-98个月.中位生存时间37个月.1、3、5年存活率分别为100%(32/32)、53%(17/32)、19%(6/32).患者生存期与治疗前血清PSA(r=-0.262,P=0.045)、Gleason评分(r=0.624,P=0.001)呈负相关,与治疗前睾酮水平(r=0.514,P=0.008)及年龄(r=0.311,P=0.032)呈正相关,与治疗前穿刺活检阳性点数(r=0.211,P=0.158)及临床分期(r=0.058,P=0.352)无关. 结论转移性前列腺癌预后与患者术前睾酮水平、年龄、Gleason评分、血清PSA有关,与治疗前穿刺活检阳性点数及临床分期无关.
목적 탐토전이성전렬선암적예후급상관인소. 방법 전이성전렬선암환자32례.평균년령71(54～87)세.균경직장표준6점전렬선천자활검증실위전렬선암,양성점수1～2점4례、3～4점7례、5～6점21례.Gleason평분2～6분2례、7분19례、8～10분11례.림상분기T_(1-2c)N_1M_0 6례、T_(2c)N_1M_1 1례、T_(3a)N_1 M_1 13례、T_(3a)N_2 M_1 2례、T(3b)N_1 M_1 5례、T_(3b)N_2 M_1 1례、T_4N_1 M_1 4례.치료전혈청PSA치63～2000 ng/ml,중위수158 ng/ml;혈청고동평균11.4(4.4～50.7)nmol/L.골전이27례,기중합병분강림파결전이8례,단순림파결전이5례.채용수술거세가웅격소조단(비잡로알50 mg/d혹불타알250 mg 3차/d)치료.일선내분비치료시간7～48개월,중위시간23개월.일선내분비치료실패후,개용기희자분혹자이순담개치료,41%적환자대이선내분비치료불민감,59%적환자대이선치료유효,지속시간3～15개월.통계학분석환자예후여치료전각지표적상관성. 결과 32례환자평균수방33(13～98)개월.28례학진후13～86개월사망.존활4례,수방78-98개월.중위생존시간37개월.1、3、5년존활솔분별위100%(32/32)、53%(17/32)、19%(6/32).환자생존기여치료전혈청PSA(r=-0.262,P=0.045)、Gleason평분(r=0.624,P=0.001)정부상관,여치료전고동수평(r=0.514,P=0.008)급년령(r=0.311,P=0.032)정정상관,여치료전천자활검양성점수(r=0.211,P=0.158)급림상분기(r=0.058,P=0.352)무관. 결론 전이성전렬선암예후여환자술전고동수평、년령、Gleason평분、혈청PSA유관,여치료전천자활검양성점수급림상분기무관.
Objective To discuss the prognosis of the metastatic prostatic carcinoma and analyze the relative factors. Methods From 2001 to 2002, 32 cases of matastatic prostatic carcinoma were admitted to our hospital, the ages ranging from 54 to 87, with the mean age of 71 years. All the diagnosis was proved by the six cores transrectal biopsy of the prostate. The serum PSA ranged from 63 to 2000 ng/ml. Two cases had the Gleason score of 2 - 6, 19 cases had the Gleason score of 7 and 11 cases had the Gleason score of 8 - 10. Preoperative routine examinations included serum testosterone, pelvic CT or MRI scan, CXR and bone scan. Twenty-seven cases were found to have osseous metastasis, among them 8 cases combined with lymph nodes metastasis, and 5 cases with lymph nodes metastasis only. All of them were treated with gonadectomy and the blockade of the androgen receptor (with Bicalutamide 50 mg/d or Flutamide 250 mg/d). It lasted 7 - 48 months with first endocrine therapy,and mid last time 23 months. After first line endocrine therapy failure, Diethylstilbestrol and Estramustine were used in the androgen-independent stage. Thirteen cases were not effective, and second therapy had effect to 19 cases and it lasted for 3 - 15 months. Results The follow-up periods ranged from 13 to 98 months, with the mean period of 33 months. Twenty-eight cases died, 4 cases survived. The median survial period was 37 months, 1-year survival rate was 100% (32/32), 3-year survival rate was 53%(17/32) , 5-year survival rate was 19%(6/23). As to the survival period, there were negative correlaions between survival and the level of PSA (r= -0. 262, P=0. 045) and the Gl-eason score (r=- 0. 624, P=0. 001). There were positive correlations between survival and the level of testosterone (r=0. 514, P=0. 008) and the age (r=0. 311, P = 0. 032). And there was no correlation between survival and the number of the positive cores of the biopsy (r=0. 211, F = 0. 158) and the clinical stage (r=0. 211, P = 0. 352). Conclusions As to the metastatic prostatic carcinoma, there are correlations between the survival and the levels of testosterone before treatment, age, the Gl-eason score and the level of PSA. There is no relationship between the survival period of the metastatic prostatic carcinoma and the number of the positive cores of the biopsy and the clinical stage.