摘要
目的:探究延长前列腺癌患者进展为激素非依赖性前列腺癌(AIPC)时间的内分泌治疗方法。方法:经直肠活检穿刺证实前列腺癌患者93例,分为3组:22例患者接受双侧睾丸切除加比卡鲁胺联合治疗,行持续性全雄激素阻断(CAD);71例患者行间歇性内分泌治疗方法,其中29例患者行标准间歇性内分泌治疗(IAD),42例患者行改良型间歇性内分泌治疗;两组治疗期用戈舍瑞林或亮丙瑞林联合比卡鲁胺的用药方案,行雄激素最大阻断(MAB),当患者血清PSA下降至<0.2μg/L,维持用药3个月。进入间歇期,IAD组停药,改良型IAD组停用促黄体生成激素释放激素类似物(LHRH-a),但维持使用比卡鲁胺,两组在间歇期内出现PSA持续升高,且大于4μg/L时,则再次启用MAB,直至患者进展为AIPC。比较CAD、IAD及改良型IAD 3组患者疾病随访时间、疾病进展时间及治疗周期。结果:3组患者人口学特征、基线资料及随访时间相似,中位进展时间分别为(26.50±4.15)月、(30.00±7.83)月和(34.93±5.08)月,CAD与标准IAD组比较差异无统计学意义(P=0.143),改良型IAD组与CAD及IAD组比较差异有统计学意义(P=0.001,0.032)。Kaplan-Meier生存分析显示,改良组中位进展时间明显长于标准IAD治疗组(P=0.01)。标准IAD与改良型IAD组平均治疗周期分别为(16.13±3.33)月和(19.58±4.30)月,两组第1治疗周期间歇期分别为(9.6±3.2)月和(14.2±3.7)月,组间比较差异显著(P=0.001)。结论:与CAD和标准IAD比较,改良型IAD可显著延长前列腺癌患者进展为AIPC的时间。
Objective： To search for an effective hormonal therapy for delaying the progression of prostate cancer to androgen- independent prostate cancer （AIPC）. Methods ： This study included 93 cases of prostate cancer confirmed by transrectal ultrasound- guided biopsy, 22 treated by bilateral orehiectomy plus bicalutamide as a continuous androgen deprivation （CAD） therapy, and the other 71 by the intermittent androgen deprivation （IAD） therapy, the latter divided into a standard IAD group （ n = 29） and a modified IAD group （n =42） to be treated by maximum androgen blockage （MAB） until the serum PSA level decreased to less than 0.2 μg/L and the medication was maintained for 3 months. Entering the intermittent period, the patients of the standard IAD group discontinued medication, while those in the modified IAD group withdrew luteinizing hormone-releasing hormone analogue （LHRH-a） but continued the use of bicalutamide. MAB was resumed in these two groups when serum PSA manifested a continuous rise and went up to 4 μg/L until prostate cancer progressed to AIPC. Comparisons were made among the CAD, standard IAD and modified IAD groups in the fol- low-up time, time of progression to CRPC and treatment cycles. Results ： The three groups of patients were well balanced in terms of demographics, baseline characteristics and follow-up time. The median times of progression to AIPC in the CAD, standard IAD andmodified IAD groups were （ 26, 50 ± 4.15 ）, （ 30.00 ± 7.83 ） and （ 34.93 ± 5.08 ） months, respectively, with statistically significant differences between the modified IAD group and the CAD （P = 0. 001 ） and standard IAD （P = 0. 032） , but not between the latter two groups （P = 0. 143 ）. Kaplan-Meier survival curves showed a significantly longer median time of progression to AIPC in the modified than in the standard IAD group （ P = 0.01 ）. The mean cycle length was （ 16.13 ± 3.33 ） months for the standard IAD group and （ 19.58 ± 4.30） months for the modified IAD group, and the time off treatment of the first cycle was （9.6 ± 3.2） months in the former and （ 14.2 ± 3.7 ） months in the latter, with significant difference between the two groups （ P = 0. 001 ）. Conclusion ： Compared with CAD and standard IAD, modified IAD therapy can significantly prolong the time of progression to AIPC in patients with prostate cancer.
出处
《中华男科学杂志》
CAS
CSCD
2013年第9期815-819,共5页
National Journal of Andrology
关键词
前列腺癌
持续性雄激素阻断
间歇性雄激素阻断
激素非依赖性前列腺癌
prostate cancer
continuous androgen deprivation
intermittent androgen deprivation
androgen-independent pros-tate cancer
