Taylor C D, Elson P, Trump D L
Division of Hematology/Oncology, Lawrence Memorial Hospital of Medford, MA 02155.
J Clin Oncol. 1993 Nov;11(11):2167-72. doi: 10.1200/JCO.1993.11.11.2167.
Patients in whom prostate cancer progresses despite testicular androgen ablation are generally said to have cancers that have become resistant to hormonal maneuvers. If androgen suppression has been pharmacologic, this therapy is often stopped before consideration of other systemic treatments. This exploratory study sought clinical correlates of experimental evidence that there may be substantial acceleration of tumor growth after cessation of androgen suppression.
A retrospective multivariate analysis was performed on survival data for 341 patients treated on four clinical trials of secondary therapy for hormone-refractory prostate cancer. Factors included in the model were recent weight loss, age, performance status, disease site (soft tissue v bone-dominant), prior radiotherapy, and continued androgen suppression v discontinued exogenous endocrine therapy.
Recent weight loss, age, performance status, and disease site were important prognostic factors for survival duration in hormone-refractory prostate cancer. Correcting for these factors, continued testicular androgen suppression was also an important predictor of survival duration in all data sets examined.
This retrospective study showed a modest advantage in survival duration for men with hormone-refractory prostate cancer who continued to receive testicular androgen suppression. The hypothesis that continued hormonal maneuvers can still affect survival in this group warrants examination in prospective trials.
尽管进行了睾丸雄激素去除治疗，但前列腺癌仍进展的患者通常被认为患有对激素治疗产生耐药的癌症。如果雄激素抑制是通过药物进行的，这种治疗通常会在考虑其他全身治疗之前停止。这项探索性研究旨在寻找实验证据的临床相关因素，即雄激素抑制停止后肿瘤生长可能会大幅加速。
对在四项激素难治性前列腺癌二线治疗临床试验中接受治疗的341例患者的生存数据进行回顾性多变量分析。模型中纳入的因素包括近期体重减轻、年龄、体能状态、疾病部位（软组织为主还是骨转移为主）、既往放疗以及持续雄激素抑制与停止外源性内分泌治疗。
近期体重减轻、年龄、体能状态和疾病部位是激素难治性前列腺癌生存时间的重要预后因素。校正这些因素后，持续睾丸雄激素抑制也是所有研究数据集中生存时间的重要预测因素。
这项回顾性研究表明，继续接受睾丸雄激素抑制的激素难治性前列腺癌男性患者在生存时间上有适度优势。持续激素治疗仍可影响该组患者生存的假设值得在前瞻性试验中进行检验。
