晚期前列腺癌患者行间歇性内分泌治疗的疗效分析

目的探讨间歇性内分泌治疗在晚期前列腺癌患者中的疗效,并分析影响疗效的相关因素。方法2004年9月到2012年7月间收治晚期前列腺癌患者首先进行6-9个月的内分泌治疗,然后进行疗效评估,将对内分泌治疗敏感的患者随机分为间歇治疗组和持续治疗组,观察两组的疗效、毒副作用及患者的生活质量评分等指标,并分析间歇治疗组中影响患者预后的相关因素。结果共收治174例晚期前列腺癌患者,有130例患者对内分泌治疗敏感,其中58例患者接受间歇性内分泌治疗,72例患者接受持续性内分泌治疗。间歇治疗组患者的生活质量KPS评分明显高于持续治疗组（80vs70,P〈0．05）,相关并发症发生率也低于持续治疗组。但两组患者的5年内发展成为非激素依赖性前列腺癌的比例（37％vs41％）及患者的5年生存率（72％vs63％）无明显差异。Cox多因素分析显示晚期前列腺癌患者的Gleason评分及第一次治疗后PSA水平与患者的预后密切相关,可作为判断能否行间歇性内分泌治疗及预后的重要指标。结论对于晚期前列腺癌患者行间歇性内分泌治疗安全可行、疗效确切,对患者的生活质量影响小,同时也可减少患者的经济压力。

The intermittent hormonal therapy for the patients with advanced prostate cancer

Objective To investigate the efficacy of intermittent hormonal therapy for the patients with advanced prostate cancer and determine the influencing factors. Method From September 2004 to July 2012, patients with advanced prostate cancer were treated with 6 to 9 months of hormonal therapy, and then efficacy was assessed. The patients, who were sensitive to hormonal therapy treatment, were randomly divided into intermittent and continuous treatment groups, and were observed with efficacy, side effects, quality of life scores and other indicators. At last the prognostic factors for intermittent group were analyzed. Results A total of 174 patients with advanced prostate cancer were treated with hormonal therapy, and 130 patients were sensitive to it, including 58 in intermittent hormonal therapy group and 72 in continuous hormonal therapy group. The KPS scores of intermittent group was significantly higher than the continuous treatment group （80 vs 70, P〈0.05）, and the incidence of hormonal therapy-related complications was also lower in intermittent treatment group （P〈0.05）. There was no significant difference in the proportion of non-hormone dependent in 5 years （37% vs 41%） and the 5-year survival rate （72% vs 63%）. Cox multivariate analysis showed that the prognosis was closely associated with gleason score and the PSA level after the first treatment. They could be used as indicator of prognosis. Conclusions For patients with advanced prostate cancer, intermittent hormone therapy is safe, effective, little impact on quality of life, and also can reduce the financial burden of patients.