摘要
目的探讨多西他赛联合内分泌治疗对远处转移性前列腺癌的疗效和安全性。方法回顾性分析2016年4月至2019年4月天津医科大学第二医院收治的204例远处转移性前列腺癌患者的临床资料。所有患者均伴有骨转移,无内脏转移,其中转移性激素敏感性前列腺癌(mHSPC)97例,平均年龄70(42~87)岁;92例为高肿瘤负荷(存在>4处骨转移灶,其中至少1处为脊柱或骨盆外转移),5例为低肿瘤负荷;化疗前前列腺特异性抗原(PSA)中位值74.1(11.0~145.0)ng/ml;Gleason评分≤7分35例(36.1%),≥8分62例(63.9%);26例存在骨痛症状,疼痛数字评价量表(NRS)平均3.7分。转移性去势抵抗性前列腺癌(mCRPC)107例;平均年龄73(56~83)岁;化疗前PSA中位值84.5(12.4~490.2)ng/ml;Gleason评分≤7分32例(29.9%),≥8分75例(70.1%);75例存在骨痛症状,疼痛NRS平均5.4分。患者均采用多西他赛联合持续内分泌治疗(药物去势联合抗雄激素药物)。化疗方案为多西他赛75 mg/m^(2),第l天静脉滴注;泼尼松5 mg,口服,2次/d,每21天为1个周期。观察PSA无进展生存(PSA-PFS)时间、疼痛NRS分数变化、骨痛缓解率和不良反应,并分析年龄、化疗前PSA水平、Gleason评分与PSA-PFS的相关情况。结果本研究204例中位随访时间15个月。mHSPC组中,6例(6.2%)因各种原因仅行1~2个周期化疗,91例接受3~6个周期化疗,平均4.7个周期。完成≥3个周期化疗患者中,36例出现PSA进展,中位PSA-PFS时间22个月,疼痛NRS由3.9分降至3.0分,骨痛缓解率72.0%(18/25)。mCRPC组中,9例(8.4%)仅行1~2个周期化疗,98例接受3~14个周期化疗,平均5.6个周期。完成≥3个周期化疗患者中,51例出现PSA进展,中位PSA-PFS时间11个月,疼痛NRS由5.6分降至4.4分,骨痛缓解率48.6%(35/72)。亚组分析结果显示,mHSPC组PSA-PFS与年龄、化疗前PSA水平、Gleason评分无明显相关性(P均>0.05);mCRPC组PSA-PFS与化疗前PSA水平存在明显相关性(P=0.026),与年龄、Gleason评分无明显相
Objective To evaluate the efficacy and safety of docetaxel plus hormone therapy in metastatic prostate cancer.Methods From April 2016 to April 2019,204 cases with bone metastatic prostate cancer in the Second Hospital of Tianjin Medical University were analyzed retrospectively.There were 97 patients responded to hormone therapy including 92 cases with high-burden metastasis(more than 4 bone metastases with one or more beyond the axial skeleton)and 5 cases with low-burden metastasis,with average age of 70 years(range 42-87 years)and median prostate specific antigen(PSA)of 74.1 ng/ml(range 11.0-145.0 ng/ml).Among them,there were 35 patients(36.1%)with a Gleason score of 7 or lower,and 62 patients(63.9%)with a Gleason score of 8 or higher.There were 26 patients suffering from bone pain,with average numerical rating scales(NRS)score of 3.7.In addition,there were 107 patients being resistant to hormone therapy,with average age of 73 years(range 56-83 years),and median PSA of 84.5 ng/ml(range 12.4-490.2 ng/ml),including 32 patients(29.9%)with a Gleason score of 7 or lower,and 75 patients(70.1%)with a Gleason score of 8 or higher.Among them,there were 75 patients suffering from bone pain,with average NRS score of 5.4.All patients received continuous hormone therapy combined with docetaxel(at a dose of 75 mg per square meter of body-surface area every 3w,plus prednisone 5 mg twice a day),and PSA progression-free survival(PSA-PFS),NRS score,pain relief,and adverse events were analyzed.Additional analysis of the correlation between PSA-PFS and subgroups with age,PSA level and Gleason score were performed.Results For patients with metastatic hormone sensitive prostate cancer(mHSPC),6(6.2%)cases only received 1-2 cycles of chemotherapy due to different reasons,and the others received 3-6 cycles(average 4.7)with the median follow-up of 15 months.Of patients who received≥3 cycles,there were 36 cases presenting PSA progression,with the median PSA-PFS of 22 months,average NRS score decline from 3.9 to 3.0,and pain relief rate
作者
马申飞
连振鹏
常泰浩
张洪团
王晓明
刘冉录
徐勇
Ma Shenfei;Lian Zhenpeng;Chang Taihao;Zhang Hongtuan;Wang Xiaoming;Liu Ranlu;Xu Yong(Department of Urology,the Second Hospital of Tianjin Medical University Tianjin Institute of Urology,Tianjin 300000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2022年第6期430-435,共6页
Chinese Journal of Urology
基金
天津市卫生健康科技项目(ZC20116)。
关键词
前列腺肿瘤
多西他赛
化疗
内分泌治疗
转移性前列腺癌
疗效
安全性
Prostatic neoplasms
Docetaxel
Chemotherapy
Hormone therapy
Metastatic prostate cancer
Efficacy
Safety
