转移性去势抵抗性前列腺癌化疗长期疗效观察
전이성거세저항성전렬선암화료장기료효관찰
Long-term efficacy of the treatment for metastatic castration-resistant prostate cancer
  • 万方数据
    中华泌尿外科杂志 중화비뇨외과잡지
    CHINESE JOURNAL OF UROLOGY
    2013年 12期 885-890 ,共6页

    范欣荣%李汉忠%李永强%黄厚锋%周毅%张震宇%周智恩%纪志刚%毛全宗

    범흔영%리한충%리영강%황후봉%주의%장진우%주지은%기지강%모전종

    前列腺癌%化疗%多西他赛%波尼松 前列腺癌%化療%多西他賽%波尼鬆
    전렬선암%화료%다서타새%파니송
    Prostate cancer%Chemotherapy%Docetaxel%Prednisone
    目的 探讨多西他赛联合泼尼松化疗方案对转移性去势抵抗性前列腺癌(mCRPC)的长期疗效和不良反应. 方法 采用前瞻性非随机对照方法,将2005年7月至2012年3月收治的299例mCRPC患者根据是否自愿进行化疗非随机分成两组.A组102例,年龄50～ 86岁,中位年龄72岁.伴有骨转移98例,肺转移11例,肝转移5例,淋巴结转移19例.起病至进展为mCRPC时间5.4～ 123.2个月,中位时间18.6个月.化疗前tPSA 9.9～ 5000.0 μg/L,中位值94.0μg/L;Gleason评分6～10分,中位值7分;疼痛评分0～7分,中位值2分.接受多西他赛(75 mg/m2)联合小剂量泼尼松(5 mg,2次/d)3周方案进行化疗.比较化疗前后tPSA、疼痛评分、骨及可测量病灶的变化等,进行疗效评估及不良反应分析.拒绝接受化疗而采用内分泌治疗、姑息性放疗、中药治疗的197例患者为B组,年龄54～ 85岁,中位年龄73岁.伴有骨转移176例,肺转移17例,肝转移6例,淋巴结转移43例.起病至进展为mCRPC时间6.0～137.1个月,中位时间18.4个月.tPSA 5.4～1270.0 μg/L,中位值71.0μg/L;Gleason评分6～10分,中位值7分;疼痛评分0～4分,中位值2分.比较两组患者临床资料的差异,Kaplan-Meier法绘制生存曲线,比较两组生存期的差异. 结果 入组时两组的各项临床资料比较差异无统计学意义(P＞0.05).A组每周期多西他赛总剂量为100～ 170 mg,共治疗1～12周期.PSA反应显效59例(57.8％),有效21例(20.6％),进展22例(21.6％),显效及有效共80例,总有效率为78.4％;骨转移98例,化疗后好转33例(33.7％),稳定47例(48.0％),进展18例(18.4％);肺转移11例,化疗后好转5例(45.5％),稳定3例(27.3％),进展3例(27.3％);肝转移5例,化疗后好转1例,进展4例;淋巴结转移19例,化疗后好转5例(26.3％),稳定12例(63.2％),进展2例(10.5％);化疗后疼痛评分减轻38例(37.3％),稳定37例(36.3％),加重27例(26.5％).A组中位总生存期为28.3个月,B组为23.9个月,组间差异有统计学意义(P＜0.05).化疗不良反应主要为骨髓抑制、脱发、乏力、肢端麻木、甲床改变、静脉炎等. 结论 多西他赛联合泼尼松化疗方案可抑制mCRPC的进展,使总生存期延长、PSA降低、转移灶减少及缩小、减轻疼痛、改善生活质量,且化疗耐受性较好.
    목적 탐토다서타새연합발니송화료방안대전이성거세저항성전렬선암(mCRPC)적장기료효화불량반응. 방법 채용전첨성비수궤대조방법,장2005년7월지2012년3월수치적299례mCRPC환자근거시부자원진행화료비수궤분성량조.A조102례,년령50～ 86세,중위년령72세.반유골전이98례,폐전이11례,간전이5례,림파결전이19례.기병지진전위mCRPC시간5.4～ 123.2개월,중위시간18.6개월.화료전tPSA 9.9～ 5000.0 μg/L,중위치94.0μg/L;Gleason평분6～10분,중위치7분;동통평분0～7분,중위치2분.접수다서타새(75 mg/m2)연합소제량발니송(5 mg,2차/d)3주방안진행화료.비교화료전후tPSA、동통평분、골급가측량병조적변화등,진행료효평고급불량반응분석.거절접수화료이채용내분비치료、고식성방료、중약치료적197례환자위B조,년령54～ 85세,중위년령73세.반유골전이176례,폐전이17례,간전이6례,림파결전이43례.기병지진전위mCRPC시간6.0～137.1개월,중위시간18.4개월.tPSA 5.4～1270.0 μg/L,중위치71.0μg/L;Gleason평분6～10분,중위치7분;동통평분0～4분,중위치2분.비교량조환자림상자료적차이,Kaplan-Meier법회제생존곡선,비교량조생존기적차이. 결과 입조시량조적각항림상자료비교차이무통계학의의(P＞0.05).A조매주기다서타새총제량위100～ 170 mg,공치료1～12주기.PSA반응현효59례(57.8％),유효21례(20.6％),진전22례(21.6％),현효급유효공80례,총유효솔위78.4％;골전이98례,화료후호전33례(33.7％),은정47례(48.0％),진전18례(18.4％);폐전이11례,화료후호전5례(45.5％),은정3례(27.3％),진전3례(27.3％);간전이5례,화료후호전1례,진전4례;림파결전이19례,화료후호전5례(26.3％),은정12례(63.2％),진전2례(10.5％);화료후동통평분감경38례(37.3％),은정37례(36.3％),가중27례(26.5％).A조중위총생존기위28.3개월,B조위23.9개월,조간차이유통계학의의(P＜0.05).화료불량반응주요위골수억제、탈발、핍력、지단마목、갑상개변、정맥염등. 결론 다서타새연합발니송화료방안가억제mCRPC적진전,사총생존기연장、PSA강저、전이조감소급축소、감경동통、개선생활질량,차화료내수성교호.
    Objective To:investigate the role of docetaxel and prednisone on treating metastatic castration-resistant prostate cancer (mCRPC),and to report the long-term efficacy.Methods From July 2005 to March 2012,299 mCRPC patients were nonrandomised into two groups.Docetaxel (75 mg/m2) and prednisone (5 mg,bid) were given to patients in Group A,with a chemotherapy cycle of three-week.And the other patients in group B were treated with endocrine therapy,radiotherapy,traditional Chinese medicine,and so on.102 cases were nonrandomised into group A,with age range from 50 to 86 years (median 72 years),tPSA range from 9.9 μg/L to 5000.0 μg/L (median 94.0 μg/L),Gleason score range from 6 to 10 (median 7),pain score range from 0 to 7 (median 2),bone metastasis in 98 cases,lung metastasis in 1 1 cases,liver metastasis in 5 cases,lymph node metastasis in 19 cases,and the time from prostate cancer diagnosis to mCRPC range from 5.4 months to 123.2 months (median 18.6 months).The tPSA,pain score,bone scan,and metastatic focuses before and after chemotherapy were compared.197 patients were nonrandomised in group B,with age range from 54 to 85 years (median 73 years),tPSA range from 5.4 μg/L to 1270.0 μg/L (median 71.0 μg/L),Gleason score range from 6 to 10 (median 7),pain score range from 0 to 4 (median 2),bone metastasis in 176 cases,lung metastasis in 17 cases,liver metastasis in 6 cases,lymph node metastasis in 43 cases,and the time from prostate cancer diagnosis to mCRPC range from 6.0 months to 137.1 months (median 18.4 months).SPSS (v10.0),t and x2 analysis are used to evaluate the baseline differences between the 2 groups,and Kaplan-Meier survival curves are used to evaluate the overall survival between the two groups.Results There is no difference between the two group on baseline.In group A,100-170 milligram docetaxel were given for each cycle,1-12 cycles were experienced.The PSA responses were excellent in 59 cases (57.8％),effective in 21 cases (20.6％),useless in 22 cases (21.6％),and PSA response ratio was 78.4％ (80 cases).98 patients were suffered from bone metastasis.Bone scan improved in 33 cases (33.7％),stable in 47 cases (48.0％),progressed in 18 cases (18.4％).There are 11 cases with lung metastasis,improved in 5 cases (45.5％),progressed in 3 cases (27.3％),and stable in other cases after chemotherapy.There are 5 cases with liver metastasis,improved in 1 case,progressed in 4 cases.Among 19 N1 cases,lymph nodes diminished in 5 cases (26.3％),enlarged in 2 case (10.5％) and stable in 12 cases (63.2％) after chemotherapy.Pain scores were decreased in 38 cases (37.3％),increased in 27 cases (26.5％),and no different in 37 cases (36.3％).The median overall survival in group A is 28.3 months,and 23.9 months in group B.Extra median 4.4 months survival benefit is showed in group A.The common adverse events were myelosuppression,alopecia,fatigue,numbness in the end of limbs,nail changes,phlebitis.Conclusions Docetaxel combined with prednisone for the treatment of mCRPC can delay the progression of the disease,prolong the overall survival,decrease the PSA value,diminish the metastatic focuses,ease the pain,improvc thc quality of lifc,and thc tolcrance is quite good.
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