Efficacy of docetaxel neoadjuvant chemotherapy in the treatment of locally advanced and oligometastatic prostate cancer
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摘要: 目的 探讨基于多西他赛化疗联合全雄激素阻断的新辅助疗法用于治疗局部进展期及寡转移前列腺癌的有效性及安全性。方法 研究共纳入了在南京医科大学附属肿瘤医院接受新辅助化疗联合全雄激素阻断治疗的54例前列腺癌患者，包括28例局部进展期和26例寡转移前列腺癌患者。收集入组患者的基本信息、化疗情况及术后病理资料；比较局部进展期和寡转移患者之间病理的降级率、病理学完全缓解(pCR)率、切缘阳性率及PSA 90缓解率；此外，对比不同化疗周期对患者术后病理的影响；并收集患者新辅助治疗期间的不良毒副反应以探索该治疗模式的安全性。结果 新辅助治疗后，总体患者的PSA 90缓解率达85.19%；40.74%的患者出现术后ISUP级组降级，并有12.96%的患者达pCR。局部进展期和寡转移患者新辅助治疗后在PSA 90缓解率、ISUP级组变化、pCR率及术后切缘阳性率方面无显著差异。此外，在总人群中，化疗周期对PSA 90缓解率、ISUP级组变化、pCR率、化疗反应度及术后切缘阳性率无显著影响。46例(85.19%)患者在新辅助治疗过程中出现不良反应，均在对症支持治疗后好转。结论 基于多西他赛化疗联合全雄激素阻断的新辅助疗法在局部晚期和寡转移前列腺癌患者中初步展现出较为不错的应用前景，但未来仍需大样本、前瞻性的随机对照研究来验证本研究的结果。Abstract: Objective To explore the effectiveness and safety of neoadjuvant therapy based on docetaxel chemotherapy combined with total androgen blockade in the treatment of locally advanced and oligometastatic prostate cancer.Methods The study included 54 patients with prostate cancer who received neoadjuvant chemotherapy combined with total androgen blockade in Cancer Hospital Affiliated to Nanjing Medical University, including 28 patients with locally advanced prostate cancer and 26 patients with oligometastatic prostate cancer. We collected the basic characteristics, chemotherapy information and postoperative pathological results of each patient, and compared the pathological downgrading rate, pathological complete response (pCR) rate, positive margin rate and PSA 90 response rate between locally advanced and oligometastatic patients. In addition, our study investigated the effects of different chemotherapy cycles on the postoperative pathology. Finally, the adverse toxic and side effects were retrospectively collected to explore the safety of this treatment type.Results After neoadjuvant therapy, the overall PSA 90 response rate was 85.19%, 40.74% of the patients had postoperative ISUP grade group downgrade, and 12.96% of the patients reached pCR. No significant difference was detected in PSA 90 response rate, ISUP grade group downgrading, pCR rate or positive margin rate between locally advanced and oligometastatic patients. In addition, the chemotherapy cycle had no significant effect on PSA 90 response rate, ISUP grade group downgrading, chemotherapy response, pCR rate or positive margin rate. Finally, 46 patients (85.19%) had adverse toxic and side effects during neoadjuvant therapy, but all of them were improved after symptomatic support treatment.Conclusion Neoadjuvant therapy based on docetaxel chemotherapy combined with total androgen blockade has initially shown a promising application prospect in patients with locally advanced and oligometastatic prostate cancer, but large samples and prospective randomized controlled studies are still needed in the future to verify the results of this study.
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Key words:
- prostate cancer /
- neoadjuvant chemotherapy /
- efficacy analysis
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表 1 两组患者的基本资料
例(%)，X±S 变量 总例数(n=54) 局部进展期组(n=28) 寡转移组(n=26) t/χ2 P值 年龄/岁 66.67±6.81 68.64±5.61 64.54±7.44 2.300 0.026 初诊PSA/(ng·mL-1) 188.75±307.40 89.78±190.15 295.34±372.15 -2.583 0.013 穿刺ISUP分组 5.800 0.196 1级 2(3.70) 2(7.14) 0 2级 5(9.26) 4(14.29) 1(3.85) 3级 6(11.11) 1(3.57) 5(19.23) 4级 17(31.48) 9(32.14) 8(30.77) 5级 24(44.44) 12(42.86) 12(46.15) 化疗周期 3.564 0.059 ＜4 30(55.56) 19(67.86) 11(42.31) ≥4 24(44.44) 9(32.14) 15(57.69) 注：前列腺特异性抗原(PSA)；国际泌尿病理协会(ISUP)。 
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表 2 入组患者的化疗反应及术后病理情况
例(%)，X±S 变量 总例数(n=54) 局部进展期组(n=28) 寡转移组(n=26) t/χ2 P值 术前PSA/(ng·mL-1) 3.41±7.43 2.67±5.42 4.21±9.16 -0.755 0.454 术后ISUP分组 3.632 0.780 0级 7(12.96) 2(7.14) 5(19.23) 1级 4(7.41) 3(10.71) 1(3.85) 2级 4(7.41) 2(7.14) 2(7.69) 3级 8(14.81) 4(14.29) 4(15.38) 4级 4(7.41) 3(10.71) 1(3.85) 5级 24(44.44) 12(42.86) 12(46.15) 少量癌成分 3(5.56) 2(7.14) 1(3.85) pCR 1.746 0.243 是 7(12.96) 2(7.14) 5(19.23) 否 47(87.04) 26(92.86) 21(80.77) 切缘阳性 1.230 0.267 是 13(24.07) 5(17.86) 8(30.77) 否 41(75.93) 23(82.14) 18(69.23) ISUP级组变化 2.019 0.435 升级 8(14.81) 6(21.43) 2(7.69) 降级 22(40.74) 11(39.29) 11(42.31) 无变化 24(44.44) 11(39.29) 13(50.00) PSA下降率 2.016 0.253 ≥90% 46(85.19) 22(78.57) 24(92.31) ＜90% 8(14.81) 6(21.43) 2(7.69)
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表 3 不同化疗周期对化疗反应和术后病理的影响
例 变量 ＜4周期(n=30) ≥4周期(n=24) χ2 P值 升降级情况 1.458 0.573 升级 6 2 降级 11 11 无变化 13 11 PSA下降率 3.881 0.063 ≥90% 23 23 ＜90% 7 1 切缘阳性 2.026 0.155 是 5 8 否 25 16 化疗反应 3.079 0.403 0 4 6 1 4 1 2 12 12 3 10 5 pCR 1.203 0.311 是 4 6 否 26 18
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表 4 新辅助化疗联合全雄阻断治疗的不良反应
不良反应 例数 百分比/% 血液系统 粒细胞减少(Ⅰ~Ⅱ) 30 55.56 粒细胞减少(Ⅲ~Ⅳ) 9 16.67 贫血 5 9.26 血小板减少 3 5.56 消化系统 肝功能异常 7 12.96 恶心呕吐 13 24.07 大便习惯改变 9 16.67 过敏反应 严重过敏反应 0 0 皮疹 5 9.26 内分泌生殖系统 潮热、面部潮红 30 55.56 乳房发育 6 11.11 性欲减退 35 64.81 其他 7 12.96 注：其他包括下肢水肿、口腔溃疡、外周神经痛等。
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