Hussain M, Wolf M, Marshall E, Crawford E D, Eisenberger M
Veterans Administration Medical Center, Allen Park, MI.
J Clin Oncol. 1994 Sep;12(9):1868-75. doi: 10.1200/JCO.1994.12.9.1868.
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.
Analysis of five consecutive Southwest Oncology Group (SWOG) phase II chemotherapy trials was undertaken.
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 > or = 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 > or = 10 g/dL (P < .001), acid phosphatase level > or = 1.2 IU/L (P = .05), response to chemotherapy (P = .001), and > or = 2 years from initial hormone treatment (P = .01) are important factors for survival.
This study failed 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.
评估预后因素，包括持续（睾丸切除术）与中断雄激素抑制（非睾丸切除术）治疗，对激素难治性前列腺癌患者化疗反应和生存的影响。
对西南肿瘤协作组（SWOG）连续的五项II期化疗试验进行分析。
评估了205例激素难治性患者。84%接受了睾丸切除术。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）。单因素分析显示，与非睾丸切除术组相比，睾丸切除术患者从诊断到首次激素治疗的中位时间显著更长（1.1年对0.1年，P = 0.003），更有可能在诊断后≥2年开始化疗（75%对56%，P = 0.03），肝转移发生率更低（16%对30%，P = 0.05），且黑人比例更低（8%对18%，P = 0.05）。与非睾丸切除术组相比，睾丸切除术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更低，对化疗反应的可能性更低。无肝转移（P = 0.004）、血红蛋白水平≥10 g/dL（P < 0.001）、酸性磷酸酶水平≥1.2 IU/L（P = 0.05）、对化疗有反应（P = 0.001）以及从初始激素治疗开始≥2年（P = 0.01）是生存的重要因素。
本研究未显示持续性腺抑制的患者在化疗反应或生存方面有明显优势。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激素难治性前列腺癌患者无进展生存期和总生存期的影响。
