间歇性与持续性雄激素阻断治疗晚期前列腺癌疗效比较

目的 比较间歇性与持续性雄激素阻断治疗晚期前列腺癌的疗效和副反应。方法 晚期前列腺癌患者69例，分2组。A组34例行间歇性联合雄激素阻断治疗，B组35例行手术去势加抗雄激素药物即持续性雄激素阻断治疗。比较2组患者的疾病进展时间和副反应发生率。结果 A组中位随访31．5（10～60）个月，B组32．6（12～63）个月。A组患者共行60个周期治疗，平均治疗周期13．7个月，其中治疗期6．4个月、间歇期7．3个月。A、B组中位疾病进展时间分别为31、28个月，差异无统计学意义（P=0．446）；骨转移患者中A组中位疾病进展时间24个月，B组为18个月，2组比较差异有统计学意义（P=0．04）。2组副反应发生率分别为：潮热症状A组20．6％（7／34），B组62．9％（22／35）（P〈0．01）；骨质疏松A组11．8％（4／34），B组31．4％（11／35）（P〈0．05）；乳房肿痛A组14．7％（5／34），B组37．1％（13／35）（P〈0．05）。结论 对晚期前列腺癌患者行雄激素阻断治疗应首选间歇性联合雄激素阻断治疗。

Comparison of intermittent versus continuous androgen blockade in the treatment of advanced prostate cancer

Objective To compare the efficacy and side effects of total intermittent androgen blockade (IAB) versus total continuous androgen blockade (CAB) for treating patients with advanced prostate cancer. Methods The study included 69 patients with advanced prostate cancer. 01 them , 34 patients (group A) received IAB, and 35 patients (group B) underwent CAB, ie, surgical castration plus anti-an-drogen. The time to disease progression and side effect rale were compared between the 2 groups. Results The median follow-up period was 31. 5 months ( range, 10 - 60 months) in group A and 32. 6 months (12-63 months) in group B. The 34 IAB-treated patients completed 60 cycles and the mean cycle length was 13.7 months (time-on treatment and time-off treatment were 6.4 months and 7.3 months, respectively). The median time to progression was 31 months in group A and 28 months in group B, respectively; there was no significant difference between groups A and B in the progression-free survival rale ( P = 0.446). But in patients with skeletal metastasis, the median time to progression was 24 months in group A and 18 months in group B, with significant difference between the 2 groups in the progression-free survival rate (P=0.04). Side-effects were found in more patients of group B than in group A, including hot flash [62.9% (22/35) vs 20.6% (7/34) , P<0.0l ] ; osteoporosis [31.4% ( 11/35) vs 11.8% (4/34) , P< 0.05];gynecomastia[37. 1 % ( 13/35 ) vs 14. 7% (5/34) . P <0. 05 ]. Conclusions IAB is the first choice of endocrine treatment for advanced prostate cancer.