本文選題：前列腺癌 + 全雄激素阻斷　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:前列腺癌是威脅男性生命健康最常見的惡性腫瘤之一。全雄激素阻斷治療(MAB)是晚期前列腺癌的首選治療方案,但全雄激素阻斷治療后,患者進展到去勢抵抗性前列腺癌時間(TTCRPC)具有較大差異,提示并非所有的晚期前列腺癌患者都能夠從傳統(tǒng)全雄阻斷治療中獲益,本文研究擬回顧性分析我院行全雄阻斷治療前列腺癌患者的臨床資料,尋找精準(zhǔn)快速可預(yù)測進展到去勢抵抗性前列腺癌時間的臨床指標(biāo)用于早期篩選出內(nèi)分泌治療不敏感的患者,從而盡早的制定新的個體化治療方案,改善患者預(yù)后。方法:回顧性分析大連醫(yī)科大學(xué)附屬第二醫(yī)院2006年1月至2015年12月經(jīng)前列腺穿刺確診前列腺癌并行MAB治療患者121例。根據(jù)標(biāo)準(zhǔn)排除伴有其他系統(tǒng)腫瘤患者,MAB治療前進行經(jīng)尿道前列腺電切術(shù)患者,行手術(shù)去勢及臨床數(shù)據(jù)不全患者。最終有89例患者入選,所有患者隨訪時間均大于1年,其中有66例患者發(fā)生CRPC。依據(jù)患者進展為CRPC時間及隨訪時間將89例患者分為A組(CRPC進展時間≤1年)26例及B組(CRPC進展時間1年)63例。收集比較兩組患者的年齡、BMI、T分期、Gleason評分、骨ECT結(jié)果、治療前PSA、前列腺體積以及治療后PSA變化等相關(guān)指標(biāo),采用Log rank檢驗分析TTCRPC的預(yù)測因素。結(jié)果:統(tǒng)計89例全雄激素阻斷治療患者的臨床資料,其中入院基本資料為平均年齡:73.1±9.7歲,平均BMI:24.0±0.3kg/m2,平均前列腺體積:51.2±34.0ml,中位gleason評分(范圍):8(4~10)分,中位T分期(范圍):T3(2~4)期中位骨轉(zhuǎn)移數(shù)量(范圍):4(0~16)個,其中肺轉(zhuǎn)移8例。所有患者均規(guī)律接受全雄激素阻斷治療,我們對患者隨訪的時間為1~48月不等,平均時間20.6±13.0月。隨訪期間發(fā)生CRPC的患者一共66例,其中,1年內(nèi)發(fā)生CRPC的患者26例(39.4%),12~24個月發(fā)生CRPC患者12例(18.2%),24個月以上發(fā)生CRPC的患者28例(42.4%)。全雄激素阻斷治療后臨床資料為:平均PSA最低值:4.4±13.2ng/ml,平均PSA最低值時間:7.4±3.5月,其中患者的PSA最低時間多分布于4~12月間,PSA最低值時間≥6月的患者49例(55.6%)。通過t檢驗和卡方檢驗分析并比較A、B兩組患者的臨床資料,A組患者骨轉(zhuǎn)移灶數(shù)量≤5個7例(29.2%),5個19例(73.1%);平均PSA最低值:14.7±21.4ng/ml,平均PSA最低值時間:4.9±2.0月;B組患者骨轉(zhuǎn)移灶數(shù)量≤5個36例(57.1%),5個27例(42.9%);平均PSA最低值:0.2±0.6ng/ml,平均PSA最低值時間:8.4±3.6月;我們發(fā)現(xiàn)治療前骨轉(zhuǎn)移數(shù)量(P=0.09)、PSA最低值(P=0.002)以及PSA最低值發(fā)生時間(P0.001),在兩組數(shù)據(jù)中具有統(tǒng)計學(xué)差異。Log rank檢驗用于比較不同亞組CRPC進展時間預(yù)后的差異,結(jié)果顯示Gleason評分(≤6 vs.7 vs.≥8分)(P=0.01),T分期(2 vs.3 vs.≥4期)(0.033)骨轉(zhuǎn)移數(shù)量(≤5 vs.5個)(P=0.02),PSA最低值(≤0.2 ng/ml vs.0.2 ng/ml)(P0.001),PSA最低值發(fā)生時間(≤6月vs.6月)(P0.001)兩亞組中CRPC進展時間具有統(tǒng)計學(xué)差異。結(jié)論:1.臨床上,使用全雄阻斷治療的晚期轉(zhuǎn)移性前列腺患者發(fā)生CRPC時間具有明顯差異;2.Gleason≥7評分、骨轉(zhuǎn)移數(shù)量5個、T4期、PSA最低值0.2 ng/ml及PSA最低值發(fā)生時間≤6月的患者進展為去勢抵抗前列腺癌時間更短;3.其中,PSA最低值及發(fā)生時間雖與CRPC進展時間具有顯著相關(guān)性,但對于大部分患者而言,在獲得PSA最低值及最低值時間時,患者已經(jīng)治療了較長時間,失去了作為臨床指標(biāo)的早期預(yù)測作用;
[Abstract]:Objective: prostate cancer is one of the most common malignant tumor of the male health threat. The treatment of total androgen blockade (MAB) is the preferred treatment for advanced prostate cancer, but androgen deprivation therapy, patients progress to castration resistant prostate cancer (TTCRPC) with time are different, suggesting that not all prostate cancer patients from the traditional all male blocking treatment benefit, quasi retrospective analysis of clinical data for complete androgen deprivation therapy for patients with prostate cancer in our hospital for this study, looking for accurate prediction can progress to clinical indicators of castration resistant prostate cancer for early screening time is not sensitive to endocrine therapy in patients with individualized treatment and new as soon as possible, improve the prognosis of patients. Methods: a retrospective analysis of the Second Affiliated Hospital of Dalian Medical University from January 2006 to 2015 12 menstrual prostate biopsy. Diagnosis of prostate cancer in 121 cases of MAB patients treated with parallel. According to the exclusion criteria with other cancer patients, MAB treatment before transurethral resection of prostate, surgical castration and clinical data in all. Finally 89 patients were enrolled. All patients were followed up for more than 1 years, of which 66 cases of patients with progression according to CRPC CRPC. with time and follow-up of 89 patients were divided into A group (CRPC < 1 years in 26 cases) and B group (CRPC in 1 years) collected in 63 cases. The two groups were comparable in age, BMI, T stage, Gleason score, bone ECT results before treatment, PSA. After the treatment of prostate volume and change of PSA and other related indicators, analyzed by Log rank test predictive factors of TTCRPC. Results: 89 cases of androgen deprivation therapy in patients with clinical data, the admission of the basic data for the average age: 73.1 + 9.7 years, an average of BMI:24.0 + 0.3kg/m2, 騫沖潎鍓嶅垪鑵轟綋縐，

本文編號：1750719