Efficacy of docetaxel combined with ADT in the treatment of metastatic hormone-sensitive prostate cancer: a single-center experience
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摘要: 目的:探讨转移性激素敏感性前列腺癌(metastatic hormone-sensitive prostate cancer, mHSPC)患者接受多西他赛+雄激素剥夺疗法(androgen-deprivation therapy, ADT)治疗的有效性及影响因素。方法:回顾性分析2015年2月—2018年3月在我院新诊断为mHSPC并接受多西他赛+ADT联合治疗的患者的临床资料,对影响联合治疗有效性的相关临床因素进行分析。结果:本研究共纳入75例mHSPC患者,治疗有效定义为化疗4个周期后前列腺特异性抗原(PSA)较基线下降≥50%,且影像学改变按照RECIST标准无进展。有49例患者联合治疗有效,26例患者疗效较差。单因素回归分析显示患者的体重指数(BMI)、肿瘤初始T分期、淋巴结转移、肿瘤负荷、PSA水平、中性粒细胞/淋巴细胞比值(NLR)、碱性磷酸酶、乳酸脱氢酶、总胆固醇及甘油三酯水平与联合治疗的疗效具有显著相关性(P<0.05),而吸烟饮酒、是否合并高血压及糖尿病、美国东部肿瘤协作组(ECOG)体能评分、Gleason评分与联合治疗有效性无相关性(P>0.05)。进行多因素回归分析显示仅高负荷mHSPC(OR=81.09,95%CI:1.86~353.67,P=0.02)、NLR(OR=0.007,95%CI:0.001~0.300,P=0.01)及总胆固醇水平(OR=0.05,95%CI:0.003~0.860,P=0.04)与联合治疗的疗效具有显著相关性。结论:对于mHSPC患者,初诊时肿瘤负荷、NLR及总胆固醇水平是多西他赛化疗有效性的预测因素。Abstract: Objective: To investigate the predictive factors of the effectiveness of docetaxel+androgen-deprivation therapy(ADT) in patients with metastatic hormone-sensitive prostate cancer(mHSPC).Methods: We retrospectively analyzed the clinical data of patients who were newly diagnosed with mHSPC in Second Affiliated Hospital of Anhui Medical University and received docetaxel+ADT combination therapy from February 2015 to March 2018, and the clinical factors were analyzed.Results: A total of 75 mHSPC patients were enrolled in this study. Treatment effectiveness was defined as a PSA drop of ≥50% from baseline after 4 cycles of chemotherapy, and without progression according to RECIST criteria. Combined therapy was effective in 49 patients, and the efficacy in 26 patients was poor. Univariate regression analysis showed the patient's body mass index(BMI), tumor initial T stage, lymph node metastasis, primary tumor burden, PSA level, neutrophil-lymphocyte ratio(NLR), the level of alkaline phosphatase, lactate dehydrogenase, total cholesterol and triglyceride showed a significant correlation with the chemohormonal therapy effectiveness(P<0.05). While smoking and drinking, whether with hypertension and diabetes, ECOG score and Gleason score were not associated with the effectiveness of combination therapy(P>0.05). Further multivariate analysis showed that only high-volume mHSPC(OR=81.09, 95%CI: 1.86-353.67, P=0.02), NLR(OR=0.007, 95%CI: 0.001-0.300, P=0.01) and total cholesterol(OR=0.05, 95%CI: 0.003-0.860, P=0.04) showed a significant correlation with the efficacy of combination therapy.Conclusion: Tumor burden, NLR and total cholesterol level at initial diagnosis are predictors of the effectiveness of combination therapy in mHSPC patients.
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Key words:
- prostate cancer /
- hormone-sensitive /
- docetaxel /
- endocrine therapy /
- chemotherapy
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