中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
3期
940-943
,共4页
前列腺肿瘤%抗原%骨痛
前列腺腫瘤%抗原%骨痛
전렬선종류%항원%골통
Prostatic neoplasms%Antigens%Bone pain
目的回顾性分析以骨痛为首发症状的前列腺癌患者的临床特点。方法收集2003～2010年我院51例以骨痛为首发症状的前列腺癌患者，均经前列腺穿刺或骨转移瘤病理证实。骨转移通过静脉注射555～925 MBq 99m Tc-MDP后通过SPECT/CT采集分析证实，部分经骨肿瘤切除或骨穿刺病理证实。所有患者均接受最大限度雄激素阻断的内分泌治疗。统计其骨转移的部位分布以及前列腺特异抗原（ PSA）、碱性磷酸酶（ ALP）和 Gleason 评分对骨转移的预测，分析内分泌治疗对骨痛缓解的有效性和生存分析。结果患者年龄55～85岁，平均（72.5±8.5）岁。初诊时骨转移的发生率为92.2％（47/51）。骨盆转移占21.5％，腰椎转移占29.0％，胸椎转移占15.0％，颈椎转移占3.7％。其中PSA≥20 ng/ml者44例（86.2％），其骨转移率达100％；DRE检查阳性者39例（76.5％）；Gleason≥8分者20例（39.2％）；cTNM分期≥T3期者39例（76.5％）。经治疗后80％的患者骨痛症状缓解。1年、3年、5年生存率分别为88.7％、67.8％、54.1％。结论中老年男性以骨痛为首发症状的要考虑发生前列腺癌的可能，若患者PSA≥20 ng/ml，DRE触及结节，Gleason≥8分，cTNM分期≥T3期，发生骨转移的机会大。转移以骨盆、腰椎转移率最高。内分泌治疗可有效缓解骨痛和转移进展。 PSA与骨转移有关。
目的迴顧性分析以骨痛為首髮癥狀的前列腺癌患者的臨床特點。方法收集2003～2010年我院51例以骨痛為首髮癥狀的前列腺癌患者，均經前列腺穿刺或骨轉移瘤病理證實。骨轉移通過靜脈註射555～925 MBq 99m Tc-MDP後通過SPECT/CT採集分析證實，部分經骨腫瘤切除或骨穿刺病理證實。所有患者均接受最大限度雄激素阻斷的內分泌治療。統計其骨轉移的部位分佈以及前列腺特異抗原（ PSA）、堿性燐痠酶（ ALP）和 Gleason 評分對骨轉移的預測，分析內分泌治療對骨痛緩解的有效性和生存分析。結果患者年齡55～85歲，平均（72.5±8.5）歲。初診時骨轉移的髮生率為92.2％（47/51）。骨盆轉移佔21.5％，腰椎轉移佔29.0％，胸椎轉移佔15.0％，頸椎轉移佔3.7％。其中PSA≥20 ng/ml者44例（86.2％），其骨轉移率達100％；DRE檢查暘性者39例（76.5％）；Gleason≥8分者20例（39.2％）；cTNM分期≥T3期者39例（76.5％）。經治療後80％的患者骨痛癥狀緩解。1年、3年、5年生存率分彆為88.7％、67.8％、54.1％。結論中老年男性以骨痛為首髮癥狀的要攷慮髮生前列腺癌的可能，若患者PSA≥20 ng/ml，DRE觸及結節，Gleason≥8分，cTNM分期≥T3期，髮生骨轉移的機會大。轉移以骨盆、腰椎轉移率最高。內分泌治療可有效緩解骨痛和轉移進展。 PSA與骨轉移有關。
목적회고성분석이골통위수발증상적전렬선암환자적림상특점。방법수집2003～2010년아원51례이골통위수발증상적전렬선암환자，균경전렬선천자혹골전이류병리증실。골전이통과정맥주사555～925 MBq 99m Tc-MDP후통과SPECT/CT채집분석증실，부분경골종류절제혹골천자병리증실。소유환자균접수최대한도웅격소조단적내분비치료。통계기골전이적부위분포이급전렬선특이항원（ PSA）、감성린산매（ ALP）화 Gleason 평분대골전이적예측，분석내분비치료대골통완해적유효성화생존분석。결과환자년령55～85세，평균（72.5±8.5）세。초진시골전이적발생솔위92.2％（47/51）。골분전이점21.5％，요추전이점29.0％，흉추전이점15.0％，경추전이점3.7％。기중PSA≥20 ng/ml자44례（86.2％），기골전이솔체100％；DRE검사양성자39례（76.5％）；Gleason≥8분자20례（39.2％）；cTNM분기≥T3기자39례（76.5％）。경치료후80％적환자골통증상완해。1년、3년、5년생존솔분별위88.7％、67.8％、54.1％。결론중노년남성이골통위수발증상적요고필발생전렬선암적가능，약환자PSA≥20 ng/ml，DRE촉급결절，Gleason≥8분，cTNM분기≥T3기，발생골전이적궤회대。전이이골분、요추전이솔최고。내분비치료가유효완해골통화전이진전。 PSA여골전이유관。
Objective To analyze the clinical characteristics of prostate cancer with bone pain as the first clinical manifestation retrospectively .Methods During the time period from 2003 to 2010 ,a total of 51 patients with newly diagnosed , histologically confirmed prostate cancer , histological diagnosis was carried through the transrectal ultrasonography guided biopsy and carried on Gleason score assessment .Metastases were confirmed by positive bone scintigraphy with 555-925 MBq 99m Tc-MDP using Emission Computed Tomography ,some of which were identified by pathology of excision of metastatic bone tumor or bone marrow aspiration ,all of those patients had been treated by androgen deprivation treatment ,analyse interactions between PSA ,Gleason score,ALP and bone metastasis,discuss the therapeutic effectiveness of hormonal therapy in relieving bone pain .Results The age of the patients ranged from 55 to 85 years,with the mean age of(72.5 ±8.5)years.The metastasis of pelvis,lumbar,cervical vertebrae and thoracic vertebra was 21.5%,29.0%,3.7%and 15.0%respectively .The initial serum PSA levels >20 ng/ml was found in 44 patients ( 86.2%) with bone metastasis .39 patients ( 76.5%) presented with digital rectal examination positive and 33 patients(64.7%)with clinical stages≥T3 and 22 patients(43.1%) with high GS(8-10).80% of patients obtained the relief of bone pain .1,3,5-year survival rate were 88.7%,67.8%,54.1% respectively. Conclusions Medium-elderly men with bone pain as initial clinical manifestations should take prostate cancer into account , ECT should be considered when patients of prostate cancer were in accordance with the following characteristics:PSA≥20 ng/ml;Gleason≥8;clinical stages≥T3;digital rectal examination positive;bone pain. Metastasis of pelvis ,lumbar was much higher .It had statistical significance between PSA value and bone metastasis ( P<0.05 ) .The hormonal therapy can relieve the symptoms of bone pain and delay progression of metastasis .
