论文部分内容阅读
目的:探讨间断雄激素阻断法(IAD)治疗进展期前列腺癌的安全性及用药周期特征。方法:178例进展期前列腺癌患者依据临床分期分为A(T3-4N0M0)、B(TXN1M0)和C(TXNXM1)3组。所有患者一经确诊即给予最大雄激素阻断治疗至少6个月,至PSA≤0.2μg/L后维持3个月后,暂停雄激素阻断治疗,进入间歇期(Off-Period);当PSA>4μg/L时,进入用药期(On-Period),直至PSA再次达到0.2μg/L以下停药。分别记录各组患者年龄、初始PSA值、Gleason评分以及治疗期间每个周期的用药期及停药期时间、PSA水平及肿瘤进展时间。结果:A、B、C 3组患者初始PSA水平分别为(27.5±14.6)、(43.4±21.8)、(62.8±44.6)μg/L(P<0.01);平均随访时间分别为(38.4±9.6)、(33.1±14.0)、(28.3±14.3)个月;开始治疗至出现肿瘤进展的平均时间为(37.4±6.6)、(27.4±10.2)、(16.6±4.4)个月。A组患者平均间歇期时间显著长于B组和C组,C组患者On/Off值显著大于A组,且完成的IAD周期数显著少于A组(P<0.01)。19例A组患者完成5个治疗周期。C组患者最多完成3个治疗周期即出现PSA及肿瘤进展。2例A组患者死于心血管事件;B组患者6例死亡,其中1例死于前列腺癌转移;C组36例死亡,其中21例死于转移性前列腺癌。结论:与存在远处转移的前列腺癌患者相比,局部进展性前列腺癌患者采用间断雄激素阻断治疗可有效缓解肿瘤进展,减少IAD治疗的相关不良反应,提高患者生活质量。
Objective: To investigate the safety and medication cycle characteristics of intermittent androgen blockade (IAD) in the treatment of advanced prostate cancer. Methods: 178 patients with advanced prostate cancer were divided into A (T3-4N0M0), B (TXN1M0) and C (TXNXM1) groups according to clinical stage. All patients were given maximum androgen blockade for at least 6 months after diagnosis. After three months after PSA ≤ 0.2 μg / L, the androgen blockade therapy was stopped and entered the off-period. When PSA> 4μg / L, into the period (On-Period) until the PSA again reached 0.2μg / L the following withdrawal. The age of patients, initial PSA, Gleason score, medication duration and withdrawal period, PSA level and tumor progression time of each cycle were recorded. Results: The initial PSA levels in group A, B and C were (27.5 ± 14.6), (43.4 ± 21.8) and (62.8 ± 44.6) μg / L, respectively (P <0.01). The average follow-up time was 38.4 ± 9.6 ), (33.1 ± 14.0) and (28.3 ± 14.3) months, respectively. The mean time from initiation of treatment to progression of tumor was (37.4 ± 6.6), (27.4 ± 10.2) and (16.6 ± 4.4) months, respectively. The mean intermission time in group A was significantly longer than that in group B and C, and the On / Off values in group C were significantly greater than those in group A, and the number of completed IAD cycles was significantly less than that in group A (P <0.01). 19 patients in group A completed 5 cycles of treatment. Patients in group C completed PSA and tumor progression up to 3 cycles of treatment. Two patients in group A died of cardiovascular events; six patients in group B died, one patient died of prostate cancer metastasis; and 36 patients died in group C, and 21 patients died of metastatic prostate cancer. CONCLUSIONS: Compared with patients with prostate cancer who have distant metastases, discontinuation of androgen blockade in patients with locally advanced prostate cancer can effectively reduce tumor progression, reduce adverse reactions associated with IAD, and improve patients’ quality of life.