多西他赛再挑战治疗转移性去势抵抗性前列腺癌的疗效及预后因素

段丽群; 张曲; 刘三河; 邓康俐; 魏少忠

doi:10.3971/j.issn.1000-8578.2019.19.0626

多西他赛再挑战治疗转移性去势抵抗性前列腺癌的疗效及预后因素

Efficacy and Prognostic Factors of Docetaxel Rechallenge on Metastatic Castration-resistant Prostate Cancer Patients

摘要

摘要:
目的评价多西他赛再挑战治疗一线多西他赛治疗有效的转移性去势抵抗性前列腺癌（mCRPC）患者的疗效，并分析预后因素。
方法回顾性分析120例mCRPC患者的临床资料，观察终点为第一序列多西他赛化疗后前列腺特异性抗原无疾病进展生存期（PSA PFS）和多西他赛再挑战后前列腺特异性抗原无疾病进展生存期（Rechallenge PSA PFS）以及mCRPC患者总生存期（OS）。采用Cox单因素和多因素回归模型对患者PSA PFS、Rechallenge PSA PFS和OS相关的预后因素进行分析。
结果中位随访时间32.73（13.27~98.56）月，30例（25%）患者仍存活。中位PSA PFS 13.89（7.67~39.00）月，中位Rechallenge PSA PFS 5.29（1.25~20.00）月，中位OS 27.13（12.40~60.50）月。多因素回归分析显示：第一序列多西他赛化疗与多西他赛再挑战之间的治疗间歇期（> 6月vs.≤6月）与患者的PSA PFS显著相关，对多西他赛再挑战治疗反应性（获得部分反应vs.未获得部分反应）与Rechallenge PSA PFS显著相关，mCRPC患者就诊时基础血清PSA值及对多西他赛再挑战治疗反应性（获得部分反应vs.未获得部分反应）与OS显著相关。
结论多西他赛在一线使用多西他赛有效的mCRPC患者中再次使用疗效尚可，可作为此类患者后期治疗的一种选择。

Abstract:
Objective To assess the efficacy of docetaxel rechallenge on castration-resistant prostate cancer (mCRPC) patients and to analyze prognostic factors.
Methods We retrospectively reviewed the medical history of 120 mCRPC patients treated with the first-line docetaxel chemotherapy effectively and progressed with docetaxel rechallenge. Coprimary end points were prostate specific antigen progression-free survival (PSA PFS) after the first sequence docetaxel chemotherapy, prostate specific antigen progression-free survival after docetaxel rechallenge (Rechallenge PSA PFS) and overall survival (OS). Univariable and multivariable Cox analyses were performed to determine prognostic factors associated with PSA PFS, Rechallenge PSA PFS and OS.
Results At a median follow-up of 32.73 months, 30(25%) patients were still alive. The median PSA PFS, Rechallenge PSA PFS and OS were 13.89(7.67-39.00), 5.29(1.25-20.00) and 27.13(12.40-60.50) months, respectively. In multivariate analysis, treatment-free interval between the first sequence docetaxel chemotherapy and docetaxel rechallenge (> 6 months vs. ≤6 months) was independent predictor for PSA PFS. Response of docetaxel rechallenge (partial vs. no partial) was independent predictor for Rechallenge PSA PFS. mCRPC baseline serum-PSA and response of docetaxel rechallenge (partial vs. no partial) were independent predictors for OS.
Conclusion These results further support the favorable profile of docetaxel rechallenge in mCRPC patients who were effectively treated with first-line docetaxel.

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