醋酸戈舍瑞林缓释植入剂联合比卡鲁胺片对高龄前列腺癌患者的疗效、认知功能、近期生存率的研究
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摘要
目的:研究醋酸戈舍瑞林缓释植入剂联合比卡鲁胺片对高龄(≥70岁)前列腺癌(PCA)患者的疗效及对其认知功能、近期生存率的影响。方法:将2014年11月-2016年11月我院收治的56例PCA患者按随机数字表法分为观察组和对照组,各28例。观察组患者给予醋酸戈舍瑞林缓释植入剂(腹壁皮下注射,3.6 mg/次,1次)联合比卡鲁胺片(口服,50 mg/次,qd)行最大限度雄激素阻断治疗,对照组患者采用去势治疗,术后采取多烯紫杉醇(第1天静脉滴注,75 mg/m2)联合醋酸泼尼松片(第1~21天,口服,5mg/次,bid)进行辅助治疗,两组患者疗程均为3周,并均随访12个月。观察两组患者临床疗效、蒙特利尔认知功能评估表(Mo CA)评分、血清前列腺特异性抗原(PSA)水平及12个月生存率。结果:观察组治疗总有效率为85.72%,显著高于对照组的60.71%,差异有统计学意义(P<0.05)。治疗前,两组患者Mo CA评分、血清PSA水平比较,差异均无统计学意义(P>0.05);疗程结束后,两组患者Mo CA评分均显著降低,但观察组高于对照组,差异有统计学意义(P<0.05);治疗后6、12个月,两组患者血清PSA水平均显著降低,且观察组显著低于对照组,差异有统计学意义(P<0.05),观察组患者治疗后12个月生存率为92.86%,显著高于对照组的64.29%,差异有统计学意义(P<0.05)。结论:采用非类固醇抗雄激素药物治疗高龄PCA效果显著,可减小对患者认知功能损害,改善血清PSA水平,提高治疗效果及近期生存率。
OBJECTIVE:To investigate therapeutic efficacy of Goserelin acetate sustained-release implants combined with bicalutamide in the treatment of elderly( ≥70 years old) prostate cancer patients,and its effects on cognitive function and short-term survival rate. METHODS:A total of 56 prostate cancer patients treated in our hospital from Nov. 2014 to Nov. 2016 were divided into observation group and control group according to random number table,with 28 cases in each group. Observation group was given maximal androgen blokage(MAB)treatment which was Goserelin acetate sustained-release implant(subcutaneous injection of abdominal wall,3.6 mg/times,once)combined with Bicalutamide tablet(orally,50 mg/times,qd). Control group received surgical castration,and then was given docetaxel(intravenous dripping on 1 st day) combined with Prednisone acetate tablets(1 st-21 st day,orally,5 mg/time,bid)after surgery for adjuvant therapy. Treatment course of 2 groups lasted for 3 weeks,and all patients were followed up for 12 months. Clinical efficacy,Montreal cognitive function assessment table(Mo CA)score,serum prostate specific antigen(PSA)levels and 12-month survival rate were observed in 2 groups. RESULTS:The total response rate of observation group was significantly higher than that of control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in Mo CA score and serum PSA levels between 2 groups(P>0.05). After treatment,Mo CA scores of 2 groups were decreased significantly,and the observation group was higher than the control group,with statistical significance(P<0.05). 6 and 12 months after treatment,serum PSA levels of 2 groups were decreased significantly,and the observation group was significantly lower than the control group,with statistical significance(P<0.05);12-month survival rate of observation group(92.86%)was significantly higher than that of control group(64.29%),with statistical significance(P<0.05). CONCLUSIONS:Nonsteroidal anti-androgen drugs show significant therapeutic efficacy for elderly prostate cancer,reduce cognitive function damage,improve serum PSA levels,therapeutic efficacy and short-term survival rate.
OBJECTIVE:To investigate therapeutic efficacy of Goserelin acetate sustained-release implants combined with bicalutamide in the treatment of elderly( ≥70 years old) prostate cancer patients,and its effects on cognitive function and short-term survival rate. METHODS:A total of 56 prostate cancer patients treated in our hospital from Nov. 2014 to Nov. 2016 were divided into observation group and control group according to random number table,with 28 cases in each group. Observation group was given maximal androgen blokage(MAB)treatment which was Goserelin acetate sustained-release implant(subcutaneous injection of abdominal wall,3.6 mg/times,once)combined with Bicalutamide tablet(orally,50 mg/times,qd). Control group received surgical castration,and then was given docetaxel(intravenous dripping on 1 st day) combined with Prednisone acetate tablets(1 st-21 st day,orally,5 mg/time,bid)after surgery for adjuvant therapy. Treatment course of 2 groups lasted for 3 weeks,and all patients were followed up for 12 months. Clinical efficacy,Montreal cognitive function assessment table(Mo CA)score,serum prostate specific antigen(PSA)levels and 12-month survival rate were observed in 2 groups. RESULTS:The total response rate of observation group was significantly higher than that of control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in Mo CA score and serum PSA levels between 2 groups(P>0.05). After treatment,Mo CA scores of 2 groups were decreased significantly,and the observation group was higher than the control group,with statistical significance(P<0.05). 6 and 12 months after treatment,serum PSA levels of 2 groups were decreased significantly,and the observation group was significantly lower than the control group,with statistical significance(P<0.05);12-month survival rate of observation group(92.86%)was significantly higher than that of control group(64.29%),with statistical significance(P<0.05). CONCLUSIONS:Nonsteroidal anti-androgen drugs show significant therapeutic efficacy for elderly prostate cancer,reduce cognitive function damage,improve serum PSA levels,therapeutic efficacy and short-term survival rate.
引文
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[6]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:587-588.
[7]周毅,李汉忠,严维刚,等.局部中危前列腺癌近距离照射治疗联合最大限度雄激素阻断疗效分析[J].中华外科杂志,2015,53(4):257-260.
[8]吴楠,曾胜,马宇坤,等.最大限度雄激素阻断治疗后前列腺癌患者的认知功能状况及其影响因素分析[J].中华泌尿外科杂志,2016,37(5):349-353.
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[10]马文波,武俊平,马琳,等.手术去势联合间歇雄激素全阻断疗法治疗晚期前列腺癌的作用观察[J].河北医学,2014,20(9):1457-1459.
[11]段晓宇,朱虹,黄娟.阿仑膦酸钠对前列腺癌老年患者药物去势治疗后骨密度和骨标志物的影响[J].中国药房,2016,27(35):4974-4976.
[12]BOUTIN B,TAJEDDINE N,VANDERSMISSEN P,et al.Androgen deprivation and androgen receptor competition by bicalutamide induce autophagy of hormone-resistant prostate cancer cells and confer resistance to apoptosis[J].The Prostate,2013,73(10):1090-1102.
[13]钱苏波,沈海波,曹奇峰,等.抗雄激素撤退治疗去势抵抗性前列腺癌的疗效分析[J].现代泌尿外科杂志,2015,20(1):40-43.
[14]SHORE ND,CHOWDHURY S,VILLERS A,et al.Efficacy and safety of enzalutamide versus bicalutamide for patients with metastatic prostate cancer(TERRAIN):a randomised,double-blind,phase 2 observation[J].Lancet Oncology,2016,17(2):153-163.
[15]杨汪明.睾丸切除联合最大雄激素阻断(MAB)治疗中晚期前列腺癌的疗效观察[J].实用癌症杂志,2015,30(1):118-120.
[16]陈黎黎,徐涛,崔涛,等.比卡鲁胺联合化疗治疗去势抵抗性前列腺癌患者的疗效分析[J].中国肿瘤临床与康复,2016,21(9):1099-1101.
[17]PAN C,ROBLES D,D’ABRONZO L,et al.Abstract5750:Synergistic effects of everolimus and bicalutamide in castration-resistant prostate cancer:results from a phaseⅠ/Ⅱclinical trial[J].Cancer Research,2012,72(8):5750.
[18]LI J,XIANG S,ZHANG Q,et al.Combination of curcumin and bicalutamide enhanced the growth inhibition of androgen-independent prostate cancer cells through SAPK/JNK and MEK/ERK1/2-mediated targeting NF-κB/p65and MUC1-C[J].J Exp Clin Cancer Res,2015,34(1):1-11.
[19]何峰,满立波,王海东,等.全雄激素阻断治疗对前列腺癌老年患者认知功能的影响探讨[J].中华肿瘤防治杂志,2015,22(B11):177-178.
[20]李克勤.比卡鲁胺联合化疗治疗去势抵抗性前列腺癌的疗效分析[J].中国肿瘤临床与康复,2015,22(10):1224-1226.
[21]LI YF,ZHANG SF,ZHANG TT,et al.Intermittent triweekly docetaxel plus bicalutamide in patients with castration-resistant prostate cancer:a single-arm prospective observation using a historical control for comparison[J].Asian Journal of Andrology,2013,15(6):773-779.
[2]李刚,邓新军,罗彬,等.手术去势联合间歇性雄激素阻断疗法治疗局部进展期前列腺癌患者的临床疗效[J].中国药物经济学,2016,11(5):119-120.
[3]SQUILLACE RM,MILLER D,WARDWELL SD,et al.Synergistic activity of the m TOR inhibitor ridaforolimus and the antiandrogen bicalutamide in prostate cancer models[J].International Journal of Oncology,2012,41(2):425-432.
[4]SRIDHAR SS,JOSHUA AM,GREGG R,et al.A phaseⅡobservation of GW786034(pazopanib)with or without bicalutamide in patients with castration-resistant prostate cancer[J].Clinical Genitourinary Cancer,2014,13(2):124-129.
[5]安庚,康祥锦,张文.手术去势间断联合抗雄激素药物治疗晚期前列腺癌临床分析[J].中华肿瘤防治杂志,2015,22(B22):248-249.
[6]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:587-588.
[7]周毅,李汉忠,严维刚,等.局部中危前列腺癌近距离照射治疗联合最大限度雄激素阻断疗效分析[J].中华外科杂志,2015,53(4):257-260.
[8]吴楠,曾胜,马宇坤,等.最大限度雄激素阻断治疗后前列腺癌患者的认知功能状况及其影响因素分析[J].中华泌尿外科杂志,2016,37(5):349-353.
[9]SHIPLEY WU,SEIFERHELD W,LUKKA H,et al.Re-port of NRG Oncology/RTOG 9601,a phase 3 trial in prostate cancer:anti-androgen therapy(AAT)with bicalutamide during and after radiation therapy(RT)in patients following radical prostatectomy(RP)with p T2-3p N0 disease and an elevated PSA[J].International Journal of Radiation Oncology Biology Physics,2016,94(1):3.
[10]马文波,武俊平,马琳,等.手术去势联合间歇雄激素全阻断疗法治疗晚期前列腺癌的作用观察[J].河北医学,2014,20(9):1457-1459.
[11]段晓宇,朱虹,黄娟.阿仑膦酸钠对前列腺癌老年患者药物去势治疗后骨密度和骨标志物的影响[J].中国药房,2016,27(35):4974-4976.
[12]BOUTIN B,TAJEDDINE N,VANDERSMISSEN P,et al.Androgen deprivation and androgen receptor competition by bicalutamide induce autophagy of hormone-resistant prostate cancer cells and confer resistance to apoptosis[J].The Prostate,2013,73(10):1090-1102.
[13]钱苏波,沈海波,曹奇峰,等.抗雄激素撤退治疗去势抵抗性前列腺癌的疗效分析[J].现代泌尿外科杂志,2015,20(1):40-43.
[14]SHORE ND,CHOWDHURY S,VILLERS A,et al.Efficacy and safety of enzalutamide versus bicalutamide for patients with metastatic prostate cancer(TERRAIN):a randomised,double-blind,phase 2 observation[J].Lancet Oncology,2016,17(2):153-163.
[15]杨汪明.睾丸切除联合最大雄激素阻断(MAB)治疗中晚期前列腺癌的疗效观察[J].实用癌症杂志,2015,30(1):118-120.
[16]陈黎黎,徐涛,崔涛,等.比卡鲁胺联合化疗治疗去势抵抗性前列腺癌患者的疗效分析[J].中国肿瘤临床与康复,2016,21(9):1099-1101.
[17]PAN C,ROBLES D,D’ABRONZO L,et al.Abstract5750:Synergistic effects of everolimus and bicalutamide in castration-resistant prostate cancer:results from a phaseⅠ/Ⅱclinical trial[J].Cancer Research,2012,72(8):5750.
[18]LI J,XIANG S,ZHANG Q,et al.Combination of curcumin and bicalutamide enhanced the growth inhibition of androgen-independent prostate cancer cells through SAPK/JNK and MEK/ERK1/2-mediated targeting NF-κB/p65and MUC1-C[J].J Exp Clin Cancer Res,2015,34(1):1-11.
[19]何峰,满立波,王海东,等.全雄激素阻断治疗对前列腺癌老年患者认知功能的影响探讨[J].中华肿瘤防治杂志,2015,22(B11):177-178.
[20]李克勤.比卡鲁胺联合化疗治疗去势抵抗性前列腺癌的疗效分析[J].中国肿瘤临床与康复,2015,22(10):1224-1226.
[21]LI YF,ZHANG SF,ZHANG TT,et al.Intermittent triweekly docetaxel plus bicalutamide in patients with castration-resistant prostate cancer:a single-arm prospective observation using a historical control for comparison[J].Asian Journal of Andrology,2013,15(6):773-779.