化疗前血清胱抑素C对去势抵抗性前列腺癌预后的影响

目的 探讨化疗前血清胱抑素C(Cys C)对去势抵抗性前列腺癌(CRPC)预后的影响.方法 回顾性分析新疆军区总医院2009年1月至2015年1月明确诊断为CRPC并行多西他赛化疗的48例患者的病例资料,分析Cys C水平与临床资料和预后的关系.结果 48例患者化疗前Cys C水平与Gleason评分(x2=4.218,P=0.040)和远处转移有关(x2 =4.090,P=0.043).Cys C高表达组23例(Cys C＞1.61 mg/L),低表达组25例(Cys C≤1.61 mg/L),两组患者中位生存期分别为15.6个月和25.3个月,差异有统计学意义(x2=13.876,P＜0.001).单因素方差分析表明化疗前肿瘤TNM分期(x2 =6.934,P=0.018)、Gleason评分(x2=7.933,P=0.005)、基线前列腺特异抗原(PSA)值(x2=9.038,P=0.003)、化疗周期(x2=5.024,P=0.028)、远处转移(x2=6.963,P=0.013)和化疗前血清Cys C水平(x2=6.976,P=0.012)与CRPC患者预后有关.多因素分析结果显示,诊断时基线PSA水平(x2 =4.257,P=0,039)、化疗周期(x2 =6.245,P=0.017)、远处转移情况(x2=5.122,P=0.028)、化疗前血清Cys C水平(x2=8.172,P=0.004)为影响患者预后的独立因素,以化疗前Cys C水平的风险比最高(HR =2.394).结论 化疗前血清Cys C高表达组预后较差,化疗前Cys C水平是影响接受多西他赛化疗的CRPC患者生存期的独立危险因素,可作为评价预后的有效指标.

Prognostic value of pre-chemotherapy serum cystatin C in patients with castration-resistant prostate cancer

Objective To explore the prognostic value of pre-chemotherapy serum cystatin C (Cys C) in patients with castration-resistant prostate cancer (CRPC).Methods The medical records of 48 patients with CRPC were reviewed.These patients were diagnosed and underwent docetaxel-based chemotherapy in Xinjiang Military Command General Hospital between January 2009 and January 2015.Statistical analysis was performed to identify the clinical and prognosis value of Cys C.Results Of 48 patients with CRPC,the expression of serum Cys C before chemotherapy was related with Gleason score (x2 =4.218,P =0.040) and distant metastasis(x2 =4.090,P =0.043).23 patients was in high group (Cys C ＞ 1.61 mg/L),25 in low (Cys C ≤ 1.61 mg/L).The median survival time of high group and low group were 15.6 and 25.3 months,respectively (x2 =13.876,P ＜ 0.001).Univariate analysis showed that TNM stage (x2 =6.934,P =0.018),Gleason score (x2 =7.933,P =0.005),baseline prostate specific antigen (PSA) (x2 =9.038,P =0.003),number of chemotherapy cycles (x2 =5.024,P =0.028),distant metastases (x2 =6.963,P =0.013) and serum Cys C before chemotherapy (x2 =6.976,P =0.012) were associated with overall survival of patients with CRPC.COX multivariate analysis showed that baseline PSA at diagnosis (x2 =4.257,P =0.039),number of chemotherapy cycles (x2 =6.245,P =0.017),distant metastases (x2 =5.122,P =0.028) and serum Cys C before chemotherapy (x2 =8.172,P =0.004) were independent risk factors of overall survival of patients with CRPC,especially serum Cys C before chemotherapy (HR =2.394).Conclusion The patients with high Cys C level have poor prognosis,and the pre-chemotherapy Cys C is an independent risk factor for prognosis of CRPC patients treated with docetaxel-based chemotherapy which can be used as an effective indicator to assess the prognosis of CRPC.