初诊伴有脊柱转移的前列腺癌生存相关因素分析

摘要

Objective:Prostate cancer frequently metastasizes to the spine. In this study, we investigate the prognostic factors as-sociated with survival in patients with prostate cancer accompanied by spinal metastases at their preliminary diagnosis. Methods:Clin-ical data of 49 patients who were diagnosed with spinal metastasis from prostate cancer between January 2005 and December 2010 were analyzed. Variables including alkaline phosphatase (ALP), previous skeletal-related event, Gleason score, prostate-specific anti-gen (PSA) nadir, and time to castration resistance were obtained. Moreover, the relationship between these variables and overall sur-vival (OS) was analyzed. Survival analysis was performed by using Kaplan-Meier curves. Furthermore, the differences among the OS rates were assessed by using the log rank test. The variables were statistically significant in the univariate analysis (P<0.05) and were included in the multivariate model. Results:The average follow-up time was 64.1 months among the 49 patients. By the end of the follow-up, 41 of these patients were dead;the mean survival was 27 months. The 1-, 3-, and 5-year survival rate was 81.6%, 40.8%, and 20.4%, respectively. Univariate analysis identified that 6 variables were statistically significant prognostic factors of OS:with or without chemotherapy, ALP, previous skeletal-related event, Gleason score, PSA nadir, and time to castration resistance. The multivari-ate analysis showed that the time to castration resistance of ≥19 months and the addition of chemotherapy after disease progression are independent prognostic factors for a high OS. Conclusion:With or without chemotherapy and the time to castration resistance are the independent prognostic factors associated with survival in patients with prostate cancer accompanied by spinal metastases at first diagnosis.%目的：探讨初诊时伴有脊柱转移的前列腺癌患者与生存相关的因素。方法：收集2005年1月至2010年12月天津医科大学肿瘤医院接受内分泌治疗的前列腺癌脊柱转移患者49例，针对患者的碱性磷酸酶（ALP）、治疗前有无骨相关事件（SREs）、Gleason评分、治疗后PSA最低值、激素敏感持续时间、有无化疗行单因素分析，并对存在统计学意义者进行多因素分析。结果：平均随访时间64.1个月，死亡41例，中位生存时间为27个月，1、3、5年生存率分别是81.6%、40.8%、20.4%。单因素分析结果显示，有无联合化疗、ALP水平、治疗前是否出现SRE、Gleason评分、治疗后PSA最低值及激素敏感持续时间与总生存率（OS）有关（P<0.05）。Cox回归模型多因素分析显示，激素敏感持续时间≥19个月及联合化疗是较长生存时间的独立预后因素（P<0.05）。结论：激素敏感持续时间及进展为去势抵抗性前列腺癌（castration resistant prostate cancer，CRPC）后是否联合化疗是前列腺癌脊柱转移患者的预后独立因素。