本文選題：前列腺癌　切入點(diǎn)：內(nèi)分泌治療　出處：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：評估間歇性內(nèi)分泌治療對中晚期前列腺癌癥患者的療效，比較間歇性內(nèi)分泌治療與持續(xù)性內(nèi)分泌治療兩種治療方法的療效差異。 方法：納入2006年1月1日—2010年1月1日大連醫(yī)科大學(xué)附屬第一醫(yī)院泌尿外科診斷為中晚期前列腺癌，在本院接受分泌治療且有完整隨訪資料的患者�；颊呔惺中g(shù)或藥物去勢+比卡魯胺治療，按照間歇性內(nèi)分泌治療或持續(xù)性內(nèi)分泌治療將患者分為間歇組與持續(xù)組。間歇組治療方法為間歇性皮下注射戈舍瑞林及口服抗雄激素藥物比卡魯胺；持續(xù)組治療方法為行睪丸切除術(shù)或持續(xù)性皮下注射戈舍瑞林及口服抗雄激素藥物比卡魯胺。所有患者均規(guī)律隨訪，定期檢測PSA水平及其他檢查，收集隨訪資料。采用SPSS19.0統(tǒng)計(jì)學(xué)軟件對患者的基線資料、PSA、臨床特征、總生存率、副反應(yīng)發(fā)生率、治療費(fèi)用、進(jìn)展為雄激素非依賴性前列腺癌的時(shí)間進(jìn)行分析。 結(jié)果： 1.共收集符合納入標(biāo)準(zhǔn)并有完整資料患者183例，均通過病理證實(shí)前列腺癌，均為局部晚期前列腺癌（T3/T4/NX-1M0）或轉(zhuǎn)移性前列腺癌（任何T任何N Ml）。排除失訪患者24例，只做手術(shù)沒有口服比卡魯胺患者24例，只皮下注射戈舍瑞林沒有口服比卡魯胺患者12例。最終持續(xù)組共106例患者，其中32例患者（30.2%）接受手術(shù)去勢，74例患者（69.8%）接受藥物去勢。間歇組共17例患者，均行藥物去勢。 2.間歇組與持續(xù)組患者的PSA水平比較，治療后3個月差異無統(tǒng)計(jì)學(xué)意義（P=0.121），治療后6個月比較差異亦無統(tǒng)計(jì)學(xué)意義（P=0.948）。 3.間歇組與持續(xù)組患者的臨床癥狀比較，治療后3個月、治療后6個月排尿梗阻發(fā)生率、骨痛發(fā)生率、骨轉(zhuǎn)移灶陽性率差異均無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 4.間歇組與持續(xù)組患者的生存率比較，兩組患者總生存率差異無統(tǒng)計(jì)學(xué)意義（P=0.256）。 5．間歇組與持續(xù)組患者進(jìn)展為雄激素非依賴性前列腺癌的時(shí)間比較，兩組差異有統(tǒng)計(jì)學(xué)意義（P=0.044）。 6．間歇組與持續(xù)組患者治療期間副反應(yīng)發(fā)生率比較，除外胃腸道反應(yīng)發(fā)生率差異無統(tǒng)計(jì)學(xué)意義（P=0.081），，間歇組熱潮紅癥狀、性欲和勃起功能喪失、骨質(zhì)疏松、乳房脹痛發(fā)生率與持續(xù)組相比差異均有統(tǒng)計(jì)學(xué)意義（P=0.024、0.030、0.003、0.032）。 7.間歇組與持續(xù)組患者治療費(fèi)用比較，間歇組患者平均治療費(fèi)用為（29946±4526）元，持續(xù)組患者平均治療費(fèi)用為（84177±5247）元，兩組患者差異有統(tǒng)計(jì)學(xué)意義（P=0.000）。 結(jié)論:間歇性內(nèi)分泌治療是前列腺癌治療的有效手段，可顯著的延緩患者進(jìn)展為雄激素非依賴性前列腺癌的時(shí)間，改善尿路梗阻、骨痛骨轉(zhuǎn)移等癥狀，延長生存期，降低治療期間副反應(yīng)發(fā)生率，降低治療費(fèi)用，提高患者生活質(zhì)量。
[Abstract]:Objective: to evaluate the efficacy of intermittent endocrine therapy in patients with advanced prostate cancer and to compare the efficacy between intermittent endocrine therapy and persistent endocrine therapy.Methods: from January 1, 2006 to January 1, 2010, the patients diagnosed as advanced prostate cancer in urology department of the first affiliated Hospital of Dalian Medical University were treated with secretory therapy in our hospital and had complete follow-up data.The patients were divided into intermittent group and continuous group according to intermittent endocrine therapy or continuous endocrine therapy.The intermittent group was treated by intermittent subcutaneous injection of goserelin and oral androgen drug Bicalamine, while the continuous group was treated by orchiectomy or continuous subcutaneous injection of goserelin and oral androgen drug bizu_person1# amine.All patients were followed up regularly, PSA level and other examinations were measured regularly, and follow-up data were collected.The baseline data, clinical features, overall survival rate, incidences of side effects, cost of treatment and time of progression to androgen independent prostate cancer were analyzed by SPSS19.0 software.Results:1.A total of 183 patients who met the inclusion criteria and had complete data were collected. All of them were confirmed by pathology, all of which were locally advanced prostate cancer (T3 / T4 / NX-1M0) or metastatic prostate cancer (any T, any NMlP).24 cases were excluded, 24 cases were not treated by operation, and 12 cases were treated by subcutaneous injection of goserelin.In the final continuous group, 106 patients, including 32 patients with 30. 2% of the total, 74 patients with castration and 74 patients with castration received drug castration.In the intermittent group, 17 patients were castrated.2.There was no significant difference in PSA level between intermittent group and continuous group 3 months after treatment, and there was no significant difference at 6 months after treatment.3.There was no significant difference in the incidence of urination obstruction, bone pain and positive rate of bone metastasis between intermittent group and continuous group (P > 0.05) 3 months after treatment and 6 months after treatment.4.There was no significant difference in the overall survival rate between the intermittent group and the continuous group.5.The time of progression to androgen independent prostate cancer was significantly different between intermittent group and continuous group (P 0.044).6.The incidences of side effects in intermittent group and continuous group were not significantly different between intermittent group and continuous group. There was no significant difference in incidence rate of gastrointestinal reaction between intermittent group and continuous group, but there was no significant difference in incidence rate of gastrointestinal reaction between intermittent group and continuous group. In intermittent group, symptoms of hot fever, loss of sexual desire and erectile function, osteoporosis,The incidence of breast distending pain was significantly different from that of the continuous group.7.The average treatment cost of intermittent group and continuous group was 29946 鹵4526 yuan and 84177 鹵5247 yuan, respectively. The difference between the two groups was statistically significant.Conclusion: intermittent endocrine therapy is an effective method for the treatment of prostate cancer. It can significantly delay the progression of androgen independent prostate cancer, improve the symptoms of urinary tract obstruction, bone pain and bone metastasis, and prolong the survival time.Reduce the incidence of side effects during treatment, reduce the cost of treatment, improve the quality of life of patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.25

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