前列腺癌内分泌治疗方法研究及预后分析_黄宝星
- 1、下载文档前请自行甄别文档内容的完整性,平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益,请联系客服反馈,我们会尽快为您处理(人工客服工作时间:9:00-18:30)。
NJA
中华男科学杂志
National Journal of Andrology Zhonghua Nan Ke Xue Za Zhi
2013,
19(9):815-819http ://www.androl.cn
·论著·
Clinical Research
(临床研究)
前列腺癌内分泌治疗方法研究及预后分析
黄宝星,宿恒川,曹万里,孙福康
(上海交通大学医学院附属瑞金医院泌尿外科,上海200025)
【摘要】目的:探究延长前列腺癌患者进展为激素非依赖性前列腺癌(AIPC )时间的内分泌治疗方法。
方
法:经直肠活检穿刺证实前列腺癌患者93例,分为3组:22例患者接受双侧睾丸切除加比卡鲁胺联合治疗,行持续性全雄激素阻断(CAD );71例患者行间歇性内分泌治疗方法,其中29例患者行标准间歇性内分泌治疗(IAD ),42例患者行改良型间歇性内分泌治疗;两组治疗期用戈舍瑞林或亮丙瑞林联合比卡鲁胺的用药方案,行雄激素最大阻断(MAB ),当患者血清PSA 下降至<0.2μg /L ,维持用药3个月。进入间歇期,IAD 组停药,改良型IAD 组停用促黄体生成激素释放激素类似物(LHRH-a ),但维持使用比卡鲁胺,两组在间歇期内出现PSA 持续升高,且大于4μg /L 时,则再次启用MAB ,直至患者进展为AIPC 。比较CAD 、IAD 及改良型IAD 3组患者疾病随访时间、疾病进展时间及治疗周期。
结果:3组患者人口学特征、基线资料及随访时间相似,中位进展时间分别为(26.50ʃ
4.15)月、(30.00ʃ7.83)月和(34.93ʃ5.08)月,CAD 与标准IAD 组比较差异无统计学意义(P =0.143),改良型IAD 组与CAD 及IAD 组比较差异有统计学意义(P =0.001,0.032)。Kaplan-Meier 生存分析显示,改良组中位进展时间明显长于标准IAD 治疗组(P =0.01)。标准IAD 与改良型IAD 组平均治疗周期分别为(16.13ʃ3.33)月和(19.58ʃ4.30)月,两组第1治疗周期间歇期分别为(9.6ʃ3.2)月和(14.2ʃ3.7)月,组间比较差异显著(P =0.001)。
结论:与CAD 和标准IAD 比较,改良型IAD 可显著延长前列腺癌患者进展为AIPC 的时间。
【关键词】前列腺癌;持续性雄激素阻断;间歇性雄激素阻断;激素非依赖性前列腺癌中图分类号:R737.25
文献标志码:A
文章编号:1009-3591(2013)09-0815-05*Hormonal therapy for prostate cancer :Methods and prognosis
HUANG Bao-xing ,SU Heng-chuan ,CAO Wan-li ,SUN Fu-kang
Department of Urology ,Ruijin Hospital ,Shanghai Jiaotong University School of Medicine ,Shanghai 200015,China
【Abstract 】Objective :To search for an effective hormonal therapy for delaying the progression of prostate cancer to androgen-independent prostate cancer (AIPC ).
Methods :This study included 93cases of prostate cancer confirmed by transrectal ultrasound-guided biopsy ,22treated by bilateral orchiectomy plus bicalutamide as a continuous androgen deprivation (CAD )therapy ,and the other 71by the intermittent androgen deprivation (IAD )therapy ,the latter divided into a standard IAD group (n =29)and a modified IAD group (n =42)to be treated by maximum androgen blockage (MAB )until the serum PSA level decreased to less than 0.2μg /L and the medication was maintained for 3months.Entering the intermittent period ,the patients of the standard IAD group discontinued medication ,while those in the modified IAD group withdrew luteinizing hormone-releasing hormone analogue (LHRH-a )but continued the use of bicalutamide.MAB was resumed in these two groups when serum PSA manifested a continuous rise and went up to 4μg /L until prostate cancer progressed to AIPC.Comparisons were made among the CAD ,standard IAD and modified IAD groups in the fol-low-up time ,time of progression to CRPC and treatment cycles.
Results :The three groups of patients were well balanced in terms of
demographics ,baseline characteristics and follow-up time.The median times of progression to AIPC in the CAD ,standard IAD and
·
518·*
作者简介:黄宝星(1988-),男,山东临沂市人,硕士研究生,从事泌尿外科及男科学专业。通讯作者:孙福康,
Email :sunfukang6@126.com DOI:10.13263/ki.nja.2013.09.014