CAJ | 학술논문

目的探讨前列腺特异性抗原倍增时间(prostate-specific antigen doubling time,PSADT)在前列腺癌患者最大限度雄激素阻断(maximal androgen blockade,MAB)治疗后判断病情进展及预后中的价值.方法回顾性分析1994年1月至2010年12月接受MAB治疗的159例前列腺癌患者的临床资料.年龄54～90岁,平均74岁.治疗前血PSA 2.6～ 275.0 μg/L,中位数为46.8 μg/L.Gleason评分≤6分、7分及≥8分者分别为44、67、40例,不详8例.临床分期T1NoM0、T2N0M0期共42例,T3N0M0期18例,T4N0M0、T0N1M0、T0N0M1期92例,不详7例.计算患者PSADT并进行生存率分析,采用Cox比例风险模型多因素分析PSADT对预后的影响,并分析疾病进展情况.结果 159例随访6～126个月,平均28个月.PSADT为0.5 ～21.0个月,中位数为5.7个月.其中PSADT≥6个月71例,3年和5年生存率分别为89.4％和47.6％;PSADT＜6个月88例,3年和5年生存率分别为49.8％和30.6％,两组生存率比较差异有统计学意义(P＜0.05).Cox比例风险模型多因素分析证实PSADT是影响前列腺癌患者预后的主要因素之一,其相对危险度为2.646(P＜0.05).PSADT≥6个月组中随访期间病情发生进展14例(19.7％),PSADT＜6个月组为56例(63.6％),两组比较差异有统计学意义(P＜0.05).结论 PSADT能提示接受MAB治疗的前列腺癌患者的预后,PSADT≥6个月患者的生存率高于PSADT＜6个月患者.PSADT可用于预测前列腺癌患者接受MAB治疗后的疾病进展情况.
목적 탐토전렬선특이성항원배증시간(prostate-specific antigen doubling time,PSADT)재전렬선암환자최대한도웅격소조단(maximal androgen blockade,MAB)치료후판단병정진전급예후중적개치.방법 회고성분석1994년1월지2010년12월접수MAB치료적159례전렬선암환자적림상자료.년령54～90세,평균74세.치료전혈PSA 2.6～ 275.0 μg/L,중위수위46.8 μg/L.Gleason평분≤6분、7분급≥8분자분별위44、67、40례,불상8례.림상분기T1NoM0、T2N0M0기공42례,T3N0M0기18례,T4N0M0、T0N1M0、T0N0M1기92례,불상7례.계산환자PSADT병진행생존솔분석,채용Cox비례풍험모형다인소분석PSADT대예후적영향,병분석질병진전정황.결과 159례수방6～126개월,평균28개월.PSADT위0.5 ～21.0개월,중위수위5.7개월.기중PSADT≥6개월71례,3년화5년생존솔분별위89.4％화47.6％;PSADT＜6개월88례,3년화5년생존솔분별위49.8％화30.6％,량조생존솔비교차이유통계학의의(P＜0.05).Cox비례풍험모형다인소분석증실PSADT시영향전렬선암환자예후적주요인소지일,기상대위험도위2.646(P＜0.05).PSADT≥6개월조중수방기간병정발생진전14례(19.7％),PSADT＜6개월조위56례(63.6％),량조비교차이유통계학의의(P＜0.05).결론 PSADT능제시접수MAB치료적전렬선암환자적예후,PSADT≥6개월환자적생존솔고우PSADT＜6개월환자.PSADT가용우예측전렬선암환자접수MAB치료후적질병진전정황.
Objective To study the value of PSADT in predicting the prognosis and the possibility of disease progression for patients with prostate cancer after MAB therapy.Methods Based on the retrospective review of the history and the follow-up of 159 prostate cancer patients,who received MAB therapy in our department from January 1994 to December 2010,PSADT values were calculated and survival analysis was performed.The ages at diagnosis ranged from 54 to 90 years with a median of 74 years.The pretreatment PSA value ranged from 2.6 to 275.0 μg/L with a median of 46.8 μg/L.The patients of Gleason score ≤6,7 and ≥8 constituted 27.7％,42.1％ and 25.2％,respectively.Only 26.4％ of the patients were staged as T1N0M0-T2N0M0 and the others had locally advanced disease or metastasis.A multivariate analysis with a Cox's proportional hazard model was used and the disease progression rates in different PSADT groups were also compared.Chi-square test and Log-rank test were applied in statistic analysis.Results The 159 patients received follow-up with a median period of 28 months (6-126 m).The median PSADT of these 159 patients was 5.7 months (0.5-21.0 m).The 3-year and 5-year survival for the 71 patients,whose PSADT were not less than 6 months,were 89.4％ and 47.6％ respectively,compared with 49.8％ and 30.6％ for the other 88 patients whose PSADT were less than 6 months.The survivals were significantly different between the two groups (P ＜ 0.01).It was confirmed by a further multivariate analysis with a Cox' s proportional hazard model that PSADT was one of the predictive factors of the prognosis of these prostate cancer patients with a hazard ratio of 2.6 (P ＜ 0.01).Moreover,disease progression were found in 19.7％ of the PSADT≥6 m group during the follow-up compared with 63.6％ in the PSADT ＜6 m group.The disease progression rates were also significantly different (P ＜ 0.0 l).Conclusions PSADT can be used to predict the prognosis of patients with prostate cancer after the MAB therapy.The survival for the patients,whose PSADT are not less than 6 months,is higher than those whose PSADT less than 6 months.Meanwhile,PSADT can predict the possibility of disease progression after MAB treatment.