非那雄胺治疗去势抵抗性前列腺癌的效果
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摘要
目的探究非那雄胺在去势抵抗性前列腺癌中的应用效果。方法回顾性研究柳州市工人医院2010年1月～2016年1月收治的72例去势抵抗性前列腺癌患者的临床资料。按治疗方法不同分为对照组(氟他胺治疗组)36例和观察组(氟他胺结合非那雄胺治疗组)36例。比较两组临床治疗效果、治疗后尿流动力学变化[最大尿流率(MFR)、平均尿流率(UFR)、剩余尿量(PVR)]、血清前列腺特异抗原(PSA)、前列腺体积、肿瘤体积的变化;比较两组PSA无进展生存期、总生存期、生活质量评分及不良反应情况。结果治疗后6个月,观察组治疗有效率高于对照组(P<0.05)。观察组MFR、UFR和PVR减少量均高于对照组(P<0.05)。治疗后两组患者的PSA水平明显降低(P<0.01),且观察组PSA最低值显著低于对照组(P<0.01);观察组PSA水平维持正常者占比明显高于对照组(P<0.05);观察组前列腺体积、肿瘤体积水平低于对照组(P<0.05)。随访6～60个月,生存分析显示观察组中位PSA无进展生存期和中位生存时间比对照组更长(P<0.05)。观察组各项生活质量评分均优于对照组(P<0.05)。两组患者不良反应发生率差异无统计学意义(P>0.05)。结论非那雄胺在去势抵抗性前列腺癌患者中的应用效果显著,能够明显改善尿流动力学和PSA水平,抑制肿瘤发展,延长患者的生存时间,提高患者生活质量。
Objective To study and discuss the efficacy of Finasteride in the treatment of castration resistant prostate cancer. Methods Clinical data of 72 patients with castrated resistant prostate cancer admitted to Liuzhou Worker's Hospital from January 2010 to January 2016 were collected to study retrospectively. They were divided into control group(Flutamide treatment group) and observation group(Flutamide and Finasteride treatment) according to different treatment therapy, with 36 cases in each group. Clinical efficacy, changes of urodynamics(MFR, UFR and PVR), serum prostate specific antigen(PSA), volume of prostate and tumor were compared between the two groups. And the PSA progression-free survival time, total survival time, quality of life score and adverse reaction were also compared between the two groups. Results Six months after treatment, the effective rate of the observation group was higher than that of the control group(72.2%)(P < 0.05). The reductions of MFR, UFR and PVR of the observation group were higher than those of the control group(P < 0.05). The PSA level of the two groups significantly declined(P < 0.05), and the lowest PSA level in the observation group was lower than that in the control group(P < 0.05). The proportion of patients with normal PSA level in the observation group was significantly higher than that in the control group(P < 0.01). The prostate and tumor volume in the observation group were smaller than those in the control group(P < 0.01). Followed up for 6-24 months, survival analysis showed that the median PSA progression-free survival and total survival time of the observation group were longer than those in the control group(P < 0.05). The scores of quality of life in the observation group were higher than those of the control group(P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups( P > 0. 05).Conclusion The effect of Finasteride is significant in the patients with castration resistant prostate cancer. It can obviously improve the urodynamics and PSA level,inhibit the development of tumor, and prolong the survival time and improve quality of life.
Objective To study and discuss the efficacy of Finasteride in the treatment of castration resistant prostate cancer. Methods Clinical data of 72 patients with castrated resistant prostate cancer admitted to Liuzhou Worker's Hospital from January 2010 to January 2016 were collected to study retrospectively. They were divided into control group(Flutamide treatment group) and observation group(Flutamide and Finasteride treatment) according to different treatment therapy, with 36 cases in each group. Clinical efficacy, changes of urodynamics(MFR, UFR and PVR), serum prostate specific antigen(PSA), volume of prostate and tumor were compared between the two groups. And the PSA progression-free survival time, total survival time, quality of life score and adverse reaction were also compared between the two groups. Results Six months after treatment, the effective rate of the observation group was higher than that of the control group(72.2%)(P < 0.05). The reductions of MFR, UFR and PVR of the observation group were higher than those of the control group(P < 0.05). The PSA level of the two groups significantly declined(P < 0.05), and the lowest PSA level in the observation group was lower than that in the control group(P < 0.05). The proportion of patients with normal PSA level in the observation group was significantly higher than that in the control group(P < 0.01). The prostate and tumor volume in the observation group were smaller than those in the control group(P < 0.01). Followed up for 6-24 months, survival analysis showed that the median PSA progression-free survival and total survival time of the observation group were longer than those in the control group(P < 0.05). The scores of quality of life in the observation group were higher than those of the control group(P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups( P > 0. 05).Conclusion The effect of Finasteride is significant in the patients with castration resistant prostate cancer. It can obviously improve the urodynamics and PSA level,inhibit the development of tumor, and prolong the survival time and improve quality of life.
引文
[1]魏云飞,顾晓箭,朱清毅.去势抵抗性前列腺癌的治疗新进展[J].中华男科学杂志,2016,22(5):455-461.
[2]范海根.非那雄胺联合二甲双胍治疗老年良性前列腺增生合并糖尿病的疗效[J].中国老年学杂志,2015,35(9):2531-2532.
[3]刘兆博,王春喜.去势抵抗性前列腺癌(CRPC)的药物治疗新进展[J].中国老年学杂志,2015,35(9):2584-2586.
[4]Kim J,Davis JW,Klein EA,et al.Tissue effects in a randomized controlled trial of short-term finasteride in early prostate cancer[J].EBio Medicine,2016,7:85-93.
[5]Markiewicz MR,Lukose MA,Margarone JE,et al.The oral mucosa graft:a systematic review[J].J Urol,2007,178(2):387-394.
[6]万崇华,罗家洪,杨铮,等.癌症患者生命质量测定与应用[M].北京:科学出版社,2007:68-69,137-138.
[7]张峰波,邵强,杜源,等.经会阴前列腺24针饱和穿刺活检与14针活检在PSA<20μg/L患者中筛检前列腺癌的对比性研究[J].中华男科学杂志,2012,18(4):306-309.
[8]莫乃新,史红雷,吕忠,等.雄激素去除治疗对老年前列腺癌和前列腺增生患者血清骨代谢的影响[J].江苏医药,2015,41(11):1280-1282.
[9]韩博,戚美,谭薇薇,等.去势抵抗性前列腺癌的发生发展机制及药物治疗新进展[J].山东大学学报:医学版,2015,53(9):1-7.
[10]本刊编辑部.抗雄激素药物治疗去势抵抗型前列腺癌的机制研究进展[J].中国肿瘤临床,2016,43(15):667.
[11]王建,余微,廖桂华,等.137例前列腺增生患者接受非那雄胺治疗不同时段的疗效[J].中国老年学杂志,2016,36(7):1704-1705.
[12]聂晓枫,王增利.腹腔镜下腹膜外保留血管神经束前列腺癌根治术对患者排尿及性功能的影响[J].中国性科学,2016,25(12):14-17.
[13]梁浩文,曾四平.非那雄胺对前列腺癌防治的研究进展[J].右江医学,2016,44(4):453-455.
[14]Xu D,Ding J,Qi J.PD16-01 new insight of psa reduction during finasteride therapy[J].J Uroly,2015,193(4):e330.
[15]梁浩文,曾四平.非那雄胺对人前列腺癌PC-3细胞体外生长抑制及迁移的影响[J].广东医学,2016,37(18):2739-2741.
[16]徐瑞明,张占春,卢阳芳,等.老年中晚期前列腺癌同期调强放疗联合内分泌治疗的疗效观察[J].中国性科学,2016,25(3):27-29.
[17]Xu D,Ding J,Zhu YK,et al.The new insight of prostatespecific antigen reduction during finasteride therapy in aging men[J].Aging Clin Exp Res,2016,28(6):1-5.
[18]李国芬.Ⅰ型和Ⅱ型5α还原酶在良性前列腺增生中的表达意义[J].中国全科医学,2016,19(S1):20-22.
[19]袁萱,肖二龙,李涛,等.5α-还原酶抑制剂对前列腺癌的预防作用[J].临床泌尿外科杂志,2013,28(12):953-956.
[20]李峰,郑仿,闫家文,等.加味桂枝茯苓颗粒对大鼠前列腺增生组织血管内皮生长因子和碱性成纤维细胞生长因子表达水平的影响[J].中国全科医学,2016,19(6):693-697.
[21]Montico F,Kido LA,Hetzl AC,et al.Prostatic angiogenic responses in late life:antiangiogenic therapy influences and relation with the glandular microenvironment in the transgenic adenocarcinoma of mouse prostate(TRAMP)model[J].The Prostate,2015,75(5):484-499.
[22]钟华,郭燕丽,张丰,等.经直肠超声引导下前列腺穿刺活检结合血清PSA在诊断前列腺癌中的价值[J].第三军医大学学报,2016,38(6):638-641.
[2]范海根.非那雄胺联合二甲双胍治疗老年良性前列腺增生合并糖尿病的疗效[J].中国老年学杂志,2015,35(9):2531-2532.
[3]刘兆博,王春喜.去势抵抗性前列腺癌(CRPC)的药物治疗新进展[J].中国老年学杂志,2015,35(9):2584-2586.
[4]Kim J,Davis JW,Klein EA,et al.Tissue effects in a randomized controlled trial of short-term finasteride in early prostate cancer[J].EBio Medicine,2016,7:85-93.
[5]Markiewicz MR,Lukose MA,Margarone JE,et al.The oral mucosa graft:a systematic review[J].J Urol,2007,178(2):387-394.
[6]万崇华,罗家洪,杨铮,等.癌症患者生命质量测定与应用[M].北京:科学出版社,2007:68-69,137-138.
[7]张峰波,邵强,杜源,等.经会阴前列腺24针饱和穿刺活检与14针活检在PSA<20μg/L患者中筛检前列腺癌的对比性研究[J].中华男科学杂志,2012,18(4):306-309.
[8]莫乃新,史红雷,吕忠,等.雄激素去除治疗对老年前列腺癌和前列腺增生患者血清骨代谢的影响[J].江苏医药,2015,41(11):1280-1282.
[9]韩博,戚美,谭薇薇,等.去势抵抗性前列腺癌的发生发展机制及药物治疗新进展[J].山东大学学报:医学版,2015,53(9):1-7.
[10]本刊编辑部.抗雄激素药物治疗去势抵抗型前列腺癌的机制研究进展[J].中国肿瘤临床,2016,43(15):667.
[11]王建,余微,廖桂华,等.137例前列腺增生患者接受非那雄胺治疗不同时段的疗效[J].中国老年学杂志,2016,36(7):1704-1705.
[12]聂晓枫,王增利.腹腔镜下腹膜外保留血管神经束前列腺癌根治术对患者排尿及性功能的影响[J].中国性科学,2016,25(12):14-17.
[13]梁浩文,曾四平.非那雄胺对前列腺癌防治的研究进展[J].右江医学,2016,44(4):453-455.
[14]Xu D,Ding J,Qi J.PD16-01 new insight of psa reduction during finasteride therapy[J].J Uroly,2015,193(4):e330.
[15]梁浩文,曾四平.非那雄胺对人前列腺癌PC-3细胞体外生长抑制及迁移的影响[J].广东医学,2016,37(18):2739-2741.
[16]徐瑞明,张占春,卢阳芳,等.老年中晚期前列腺癌同期调强放疗联合内分泌治疗的疗效观察[J].中国性科学,2016,25(3):27-29.
[17]Xu D,Ding J,Zhu YK,et al.The new insight of prostatespecific antigen reduction during finasteride therapy in aging men[J].Aging Clin Exp Res,2016,28(6):1-5.
[18]李国芬.Ⅰ型和Ⅱ型5α还原酶在良性前列腺增生中的表达意义[J].中国全科医学,2016,19(S1):20-22.
[19]袁萱,肖二龙,李涛,等.5α-还原酶抑制剂对前列腺癌的预防作用[J].临床泌尿外科杂志,2013,28(12):953-956.
[20]李峰,郑仿,闫家文,等.加味桂枝茯苓颗粒对大鼠前列腺增生组织血管内皮生长因子和碱性成纤维细胞生长因子表达水平的影响[J].中国全科医学,2016,19(6):693-697.
[21]Montico F,Kido LA,Hetzl AC,et al.Prostatic angiogenic responses in late life:antiangiogenic therapy influences and relation with the glandular microenvironment in the transgenic adenocarcinoma of mouse prostate(TRAMP)model[J].The Prostate,2015,75(5):484-499.
[22]钟华,郭燕丽,张丰,等.经直肠超声引导下前列腺穿刺活检结合血清PSA在诊断前列腺癌中的价值[J].第三军医大学学报,2016,38(6):638-641.
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