局限高危前列腺癌患者接受全雄激素阻断联合近距离治疗后的PSA变化模式与其生存预后的临床关联分析

目的:探讨前列腺癌(PCa)患者治疗后PSA变化模式对其生存预后的临床影响。方法:回顾性总结近12年来114例接受全雄激素阻断(MAB)联合近距离治疗的PCa患者的临床资料,从PSA变化规律入手,初步分析患者生存预后的影响因素。结果:患者中位生存时间81(15~144)个月,1、3、5年生存率分别为91.23%、78.07%和68.42%。单因素分析显示:基线PSA水平、PSA最低值、PSA下降时间、PSA倍增时间以及PSA缓解幅度均是可能影响生存预后的临床因素。多因素分析显示:PSA最低值、PSA下降时间以及PSA缓解幅度是独立的预后因素,并分别提高了患者远期生存可能1.7、3.3和6.8倍。结论:局限高危PCa患者在接受MAB联合近距离治疗后,其PSA能否降至1μg/L以下、能否在3个月之内降至最低值,以及PSA最大缓解幅度能否达到96%等因素均是影响患者预后的独立风险因素。

Prognostic value of PSA kinetics in locally advanced prostate cancer treated by maximal androgen blockade combined with brachytherapy

Objective： To evaluate the effect of post-treatment PSA kinetics on the prognosis of prostate cancer （PCa）. Methods： We retrospectively reviewed the clinical data of 114 cases of locally advanced PCa treated by maximal androgen blockade （MAB） combined with brachytherapy, and analyzed the association of the changes in PSA kinetics with the prognosis of the patients. Results： The median survival time of the patients was 81 （ 15 - 144） months, with 1-, 3- and 5-year survival rates of 91.23%, 78.07% and 68.42% , respectively. Univariate analysis indicated that the baseline PSA level, PSA nadir, the time of PSA decreasing to nadir, PSA doubling time, and the extent of PSA declining were all predictive factors for the survival time of the PCa patients. Multi- variate analysis demonstrated that PSA nadir, the time of PSA decreasing to nadir, and the extent of PSA declining were three inde- pendent prognostic factors, which prolonged the long-term survival of the patients by 1.7, 3.2 and 6.8 times, respectively. Conclu- sion： For locally advanced PCa treated by MAB combined with brachytherapy, PSA nadir 〈 1 μg/L, the time to nadir 〈 3 months, and the extent of PSA declining 〉96% are independent prognostic factors. Natl J Androl, 2014, 20 （3） ： 229 -233