【摘要】 背景与目的:贫血是恶性肿瘤诊断及治疗过程中常见的并发症。我们主要观察联合雄激素阻断治疗(androgen-deprivation therapy,ADT)对前列腺癌患者血色素的影响及血色素与疗效的关系。方法:分析自2000年5月至2002年4月间有血色素记录的46名前列腺癌患者的资料,所有患者均接受了根治性放射治疗及联合雄激素阻断治疗(双侧睾丸去势术及氟他胺250 mg,每日三次,口服),观察去势手术前、放射治疗前、放射治疗过程中及放射治疗结束时患者Hb的变化。根据放疗前血色素的水平将患者分为贫血组(Hb<12 g/dl)和正常血色素组(Hb≥12 g/dl),采用Paired-T检验来检验放射治疗前、后及新辅助雄激素阻断治疗前至放射治疗前血色素的变化;用Cox回归模型进行无疾病进展生存率的多因素分析来了解放疗前Hb,放疗过程中最低Hb、Gleason score、T分期和治疗前PSA是否为影响无疾病进展生存率的预后因素。结果:46名患者中,新辅助雄激素阻断治疗开始至放疗前,28%的患者Hb下降≤1 g/dl,33%的患者Hb下降介于1~2 g/dl,30%的患者Hb下降超过2 g/dl;放疗期间,37%的患者Hb下降≤1 g/dl,30%的患者Hb下降介于1~2 g/dl;放射治疗前Hb<12 g/dl和Hb≥12 g/dl患者的3年无疾病进展生存率分别为65%和69%,Log-rank检验显示两者统计学差异无显著性(P=0.567);多因素分析显示治疗前PSA值,T分期和肿瘤Gleason分级是影响前列腺癌无疾病进展生存率的预后因素,放疗前Hb水平和放疗过程中的最低Hb水平与无疾病进展生存率无显著相关性。结论:联合雄激素阻断治疗导致患者血色素下降,放射治疗前及放射治疗过程中贫血对前列腺癌患者的无疾病进展生存率无显著影响。更多还原

【Abstract】 Background and purpose: Anemia is a frequent complication of malignant diseases and during the process of cancer treatment.The purpose of the study is to determine the effect of combined androgen-deprivation therapy(ADP) on hemoglobin value and the correlation between hemoglobin level and the outcome.Methods:From May,2000 to April,2002,46 patients with hemoglobin level record were analyzed,all patients were treated with external beam radiotherapy(EBRT) and combined androgen-deprivation therapy(bilateral orchiectomy,and flutamide 250 mg,tid,po).Complete blood counts were performed before neoadjuvant androgen-deprivation therapy(NADT),before RT,during RT and at the end of RT.According to the hemoglobin levels measured before irradiation,patients were stratified to normal hemoglobin cohort(Hb≥12 g/dl)and anemia cohort(Hb<12 g/dl).A paired t-test was used to evaluate the change in hemoglobin level after NADT and after radiotherapy.Univariate and multivariate analyses using Cox regression model were used to study the prognostic role of Pre-RT Hb,nadir Hb during RT,Gleason score,T stage and initial PSA.Results:Of 46 eligible patients,28% of the patients experienced a drop ≤1 g/dl in Hb from pre-NADT to before EBRT,33% of the patients experienced a drop between 1-2 g/dl,30% experienced a drop more than 2 g/dl;During EBRT,37% of the patients experienced a drop≤1 g/dl,30% of the patients experienced a drop between 1-2 g/dl;The 3-year progression free survival was 69% in patients with normal hemoglobin and 65% in anemia patients,respectively(P=0.567).For multivariate analyses,initial PSA level,T stage and Gleason sum were associated with progression free survival.Neither pre-EBRT Hb level nor the nadir Hb level during EBRT was associated with progression free survival.Conclusions:Combined androgen deprivation therapy significantly lowers hemoglobin levels in men with prostate cancer,but it seems that anemia does not influence the progression free survival of prostate cancer.更多还原