EFFECTS OF CONTINUED ANDROGEN-DEPRIVATION THERAPY AND OTHER PROGNOSTIC FACTORS ON RESPONSE AND SURVIVAL IN PHASE-II CHEMOTHERAPY TRIALS FOR HORMONE-REFRACTORY PROSTATE-CANCER - A SOUTHWEST-ONCOLOGY-GROUP REPORT
EFFECTS OF CONTINUED ANDROGEN-DEPRIVATION THERAPY AND OTHER PROGNOSTIC FACTORS ON RESPONSE AND SURVIVAL IN PHASE-II CHEMOTHERAPY TRIALS FOR HORMONE-REFRACTORY PROSTATE-CANCER - A SOUTHWEST-ONCOLOGY-GROUP REPORT
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DOI：
10.1200/jco.1994.12.9.1868
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发表时间：
1994-09-01
影响因子：
45.3
通讯作者：
EISENBERGER, M
中科院分区：
文献类型：
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作者：
HUSSAIN, M;WOLF, M;EISENBERGER, M
目的：为了评估预后因素的影响，包括继续（睾丸切除术）与停止雄激素抑制（非睾丸切除术）治疗，化疗反应和生存的患者与难治性前列腺癌。方法：分析五个连续的西南肿瘤组（SWOG）的第二阶段化疗试验进行了undertaken.Results：二百零五难治性患者进行了评估。84%的人被切除了睾丸。非睾丸切除术和睾丸切除术患者的中位生存期分别为6个月和7个月（P = 0.73）。在单因素分析中，睾丸切除术患者从诊断到首次激素治疗的中位时间显著延长（1.1 v0.1年，P = 0.003），更有可能在诊断后2年或2年内开始化疗与非睾丸切除术组相比，睾丸切除术组的肝转移发生率较低（75%对56%，P = 0.03），肝转移发生率较低（16%对30%，P = 0.05），黑人的可能性较低（8%对18%，P = 0.05）。与非睾丸切除术组相比，睾丸切除术组患者从初始激素治疗开始的中位时间略长，既往内分泌操作更多，基线碱性磷酸酶水平中位数较低，对化疗反应的可能性较低。无肝转移（P = .004），血红蛋白水平大于或等于10 g/dL（P < .001），酸性磷酸酶水平大于或等于1.2 IU/L（P = 0.05），对化疗的反应（P = 0.001），且从初始激素治疗开始≥ 2年（P = .01）是影响生存的重要因素。结论：本研究表明，持续性腺抑制的患者在化疗反应或生存方面具有明显优势。建议进行一项前瞻性随机试验，以评估该因素对接受化疗的难治性前列腺癌患者的无进展生存期和总生存期的影响。
Purpose: To assess the impact of prognostic factors, including continued (orchiectomy) versus discontinued androgen-suppression (nonorchiectomy) therapy, on chemotherapy response and survival of patients with hormone-refractory prostate cancer.Methods: Analysis of five consecutive Southwest Oncology Group (SWOG) phase II chemotherapy trials was undertaken.Results: Two hundred five hormone-refractory patients were evaluated. Eighty-four percent had been orchiectomized. The median survival durations for the nonorchiectomy and orchiectomy patients were 6 and 7 months, respectively (P = .73). In a univariate analysis, orchiectomy patients had a significantly longer median time from diagnosis to first hormone therapy (1.1 v 0.1 years, P =.003), were more likely to have had chemotherapy initiated greater than or equal to 2 years from diagnosis (75% v 56%, P = .03), had a lower incidence of liver metastases (16% v 30%, P = .05), and had lower likelihood of being black (8% v 18%, P = .05) when compared with the nonorchiectomy group. Orchiectomy patients had a marginally significant longer median time from initial hormone treatment, more prior endocrine manipulations, lower median baseline alkaline phosphatase levels, and a lower likelihood of response to chemotherapy when compared with the nonorchiectomy group. Absence of liver metastases (P = .004), hemoglobin level greater than or equal to 10 g/dL (P < .001), acid phosphatase level greater than or equal to 1.2 IU/L (P = .05), response to chemotherapy (P = .001), and greater than or equal to 2 years from initial hormone treatment (P = .01) are important factors for survival.Conclusion: This study foiled to show obvious advantages in response to chemotherapy or survival for patients with continued gonadal suppression. A prospective randomized trial is suggested to evaluate the effect of this factor on progression-free and overall survival of patients with hormone-refractory prostate cancer receiving chemotherapy.